Not everyone who used the service received personal care. 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. At the time of our inspection there were 18 people using the service. We reviewed 29 quality statements during this assessment covering safe, effective, responsive and well – led. The service had a manager registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
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JM Kamau Ltd T/A ProField, a domiciliary care agency serving 32 people, was rated Requires Improvement overall at its first inspection in April–May 2023, with warning notices issued for breaches of Regulations 12 and 17 relating to unsafe care and treatment and inadequate governance. While staff were caring and recruitment was safe, significant failures were found in risk assessment, medicines management, mental capacity compliance, staff specialist training, and governance systems.
Concerns (9)
criticalCare planning: “one person at risk of pressure sores due to their health condition had no risk assessment or care plan in place to provide information to care staff on how to mitigate this risk.”
criticalMedication management: “One person received support with a medicine that care staff had not had the specialist training to administer. This placed people at risk of harm.”
criticalStaff competency: “Care staff had not received training in catheter care, tissue viability and diabetes awareness.”
criticalConsent / capacity: “mental capacity assessments had not always been completed and best interest decisions recorded.”
criticalGovernance: “Systems to review and audit medicines administration were not in place to identify shortfalls...We found records of missed medication for two people that had not been identified by the registered manager.”
moderateRecord keeping: “During the inspection we identified missing or incomplete risk assessments for risks relating to pressure care, fire and moving and handling.”
moderateEnd-of-life care: “People's care plans did not inform staff whether people had a 'Do not attempt cardiopulmonary resuscitation' [DNACPR] in place or not.”
moderatePerson-centred care: “Peoples care plans were found to contain generic and limited information.”
moderateStaff training: “Staff had not received training in diabetes, catheter care, pressure care and interacting with autistic people and people with a learning disability.”
Strengths
· Staff received training in safeguarding vulnerable adults and understood the signs of abuse and felt confident to report concerns.
· Staff were recruited safely with pre-employment checks including references and DBS checks.
· People and relatives consistently reported staff were kind, caring, warm and respectful of privacy and dignity.
· Staff had received training in infection control and had access to PPE.
· The provider worked in partnership with other healthcare professionals such as GPs and district nurses.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesRequires improvement
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
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: End of life care and supportRequires 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 requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood