The assessment took place between 16 and 24 May 2024. Kare Plus Kingston is a domiciliary care agency providing personal care to people in their own homes. At the time of our assessment there were 8 people using the service. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. Care records had been updated and improved to provide detailed information about how people wished to be supported. This included information for care staff about people’s care needs, their daily routine, communication needs and support they required to manage risks to their safety. People received support from a consistent team of care workers who knew them well. Systems had improved to ensure there were sufficient numbers of staff. Staff received ongoing training and supervision to ensure they had the knowledge and skills to undertake their duties. There was a clear commitment to providing person centred care. Staff were respectful of people’s individual differences and provided support in line with the provider’s equality and diversity policy. People were in control of their care and were involved in all aspects of care planning. People’s decisions and choices were respected. Staff supported people to maintain their independence as much as possible. A registered manager was now in place who, together with their management team, provided clear leadership and management at the service. People, relatives and staff felt comfortable speaking with the management team and were able to have open and honest conversations with them. Any feedback provided was listened to and actioned. The provider’s governance framework had been strengthened to ensure it reviewed all areas of service delivery to ensure people received high quality care.
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Kare Plus Kingston, on its first inspection, was rated Requires Improvement overall due to regulatory breaches in medicines management (Regulation 12) and governance (Regulation 17), including MAR gaps, staff working 30 consecutive days without rest, and ineffective audit systems. Strengths were noted in staff compassion, training, safeguarding awareness, and partnership working, with Effective and Caring domains rated Good.
Concerns (9)
criticalMedication management: “Records showed people's Medicines Administration Records (MAR) had gaps and omissions, and staff had failed to use the key codes to explain as to why the medicines had not been administered.”
criticalRecord keeping: “People's MARs did not always contain the medicines dose, route or frequency for administration. This meant people were at risk of receiving their medicines at the incorrect time.”
criticalGovernance: “The provider had not developed robust governance systems to ensure the oversight and monitoring of the service was effective. Auditing systems failed to identify some of the issues found.”
criticalLeadership: “At the time of the inspection, there was not a registered manager in post. Systems had not been established to assess, monitor and mitigate risks to the health, safety and welfare of people.”
moderateStaffing levels: “Two staff members had worked 30 consecutive days between the 1 August and 31 August 2022. The extensive days worked by staff members meant there were not enough staff deployed.”
moderateIncident learning: “Incident and accident records were not clear or specific in confirming the action taken following incident occurrence, or that learning was shared.”
moderateCare planning: “Care records were not always as personalised as they could be to reflect people's preferences. These did not contain enough information on people's preferences.”
minorEnd-of-life care: “People's end of life care wishes were not always clearly recorded. There was not always clear guidance or a record that people had declined to discuss their end of life preferences.”
minorPerson-centred care: “People's independence was not always promoted as well as it could be. Whilst care records stated whether people wished to remain independent there was no clear guidance.”
Strengths
· People and relatives spoke positively about staff kindness, compassion and dignity in care delivery.
· Staff had a clear understanding of safeguarding responsibilities and how to identify and escalate suspected abuse.
· People's needs were regularly assessed via pre-admission assessments and care plans were reviewed to reflect changing needs.
· Staff received training across all relevant areas including safeguarding, manual handling, food safety, and medicines management.
· Staff received regular one-to-one supervisions and spot checks, which they found beneficial.
Quality-Statement breakdown (21)
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: End of life care and supportRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood