The Oxford Branch is a domiciliary care service that at the time of this assessment was supporting 13 people in their own homes with a regulated activity of personal care. Not everyone using the service received personal care. CQC only inspects where people receive personal care, which is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. We carried out this between assessment 30 July 2024 to 9 August 2024. This was a responsive assessment as there had been concerns raised about the service and how it managed medicines, risks to people’s care and the governance, management and sustainability of the service. The service had made improvements and we found no evidence to support the concerns. We found the provider's quality assurance systems were effective, and medicines were well managed. People received their medicine as prescribed. An effective risk management process was in place and people told us they felt safe. The service is rated Requires Improvement and until we have assessed more quality statements in Effective, Caring and Responsive the rating for this service remains the same.
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This targeted inspection of Kwikfix Recruitment Services Limited Oxford Branch found that while some improvements had been made following a warning notice, the provider remained in continued breach of Regulation 12 due to ongoing failures in safe medicines management and incident learning. Care plans had not been adequately reviewed and quality assurance systems remained ineffective, leaving the overall rating unchanged at Requires Improvement.
Concerns (5)
criticalMedication management: “care plan had been updated to reflect that they took time specific medicines, it did not identify what medicine this was, or the risk associated with this”
criticalMedication management: “initial assessment identified they required support to administer their medicines, within their care plan it stated that staff were to prompt them to take medicine”
criticalCare planning: “People's care plans had not been reviewed in order to assess people's risks and needs and document the support people required.”
moderateIncident learning: “We reviewed individual accidents and incidents and did not always see appropriate actions or outcomes documented...not clear what action the service had taken to mitigate risks”
moderateGovernance: “Not all of these actions had been completed at this inspection, which indicated further concerns about the effectiveness of the provider's quality assurance and governance systems.”
Strengths
· Staff competencies were updated and further training completed since last inspection
· Spot checks were carried out to ensure safe practice
· New care planning system implemented with relevant documentation for new clients
· Risk assessments and further information relating to diabetes had been implemented
· Staff had a good understanding of people's needs and the support they required
Kwikfix Recruitment Services Limited Oxford Branch received an overall rating of Requires Improvement at its first inspection in August 2022, with breaches of Regulations 9, 12, 13 and 17 identified relating to unsafe medicines management, inadequate risk assessments, ineffective safeguarding processes and poor governance. The service demonstrated genuine caring values among frontline staff, but systemic failures in record keeping, care planning, leadership visibility and quality assurance created significant risks to the 22 people receiving personal care.
Concerns (12)
criticalSafeguarding: “some incidents and safeguarding concerns were not recorded or passed onto the relevant authorities to ensure they were investigated properly”
criticalMedication management: “care plans did not match the services medication policy...no MAR chart in place...The service did not have protocols to ensure the safe administration of 'as required' medicine”
criticalCare planning: “four peoples records we reviewed had not been included on the system until the day before the inspection. This included care plans, risk assessments and support tasks.”
criticalRecord keeping: “Electronic records did not contain a complete and contemporaneous record in respect of each service user.”
criticalGovernance: “Quality systems were not effective or robust in identifying and driving improvement across the service. The shortfalls we found during our inspection had not been identified by the provider.”
moderatePerson-centred care: “Asked for female carers but there's not many available. Most staff are men, female staff are very few and far between.”
moderateConsent / capacity: “one person using the service was living with vascular dementia and had their medicines locked away. There was no mental capacity assessment or best interest documentation in place.”
moderateIncident learning: “Records did not include further investigation or analysis to consider how incidents occurred or identify any actions which could be taken to try to prevent a reoccurrence.”
moderateComplaints handling: “one relative that they had raised a concern regarding a missed dose of medicine. There was no record of this on the complaints log.”
moderateLeadership: “people we spoke to - including staff - were not always aware of who the registered manager was...the Registered Manager was not always visible, working one day on site a week.”
minorInfection control: “feedback from relative that staff did not always use the correct personal protective equipment (PPE).”
minorSupervision / appraisal: “We saw examples of supervision being carried out for staff; however documentation was not always specific to individual staff.”
Strengths
· Staff were described as kind, caring and compassionate by people and relatives, with comments such as 'Oh yes, they are all very kind, I've no complaints there'.
· Staff demonstrated good awareness of individual people's needs despite care plans lacking detail.
· Robust recruitment checks including DBS checks were carried out to protect people from unsuitable staff.
· Staff supported people to access healthcare services, including arranging pharmacy orders and home eye tests.
· The branch manager was described as supportive and approachable by staff, and the service culture was open and transparent.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Learning lessons when things go wrongRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experience
Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidance (MCA)Requires 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: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires 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 staffRequires improvement