Date of Assessment: 3 to 20 January 2025. Care 24/7 Healthcare Limited is a domiciliary care agency registered to provide personal and nursing care, to people living at home. There were 8 people who were being supported with personal care, some were end-of-life care. No nursing care was provided. This assessment was undertaken to review any improvements from the last inspection completed November 2022 when it was rated requires improvement with 3 breaches to regulation. The breaches to legal regulation related to good governance and suitable skilled, competent staff. Although improvements were noted, the provider remained in breach of these regulations. The provider was also in breach in relation to person centred care. Improvements found meant the provider was no longer in breach of this regulation. The service remains requires improvement with 2 breaches. Improvements made included a full assessment process supporting appropriate care packages and a person-centred approach to care. Risk assessments were now used to inform safe care. However, the service remained without effective leadership. There was no registered manager, and the provider was overseeing the service. Quality monitoring and governance systems were not robust. Staff training and induction had improved. However, there were gaps in specific areas, and ongoing monitoring and supervision of staff skills and practice. The management team responded to incidents, safeguarding and accidents proactively. However, records did not support the learning. Staff responded to safeguarding issues appropriately. Staff followed good infection control practice.
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Care 24/7 Healthcare Limited was rated Requires Improvement overall at its first inspection in November 2022, with breaches of Regulations 12, 17 and 18 identified relating to absent risk assessments, inadequate governance and insufficient staff training. Caring was rated Good, reflecting staff who were genuinely kind and person-centred, though the service was hampered by leadership instability, incomplete care plans, and a lack of quality monitoring systems.
Concerns (9)
criticalCare planning: “Individual care and support plans had not been provided for everyone. Those that were provided were limited in content and did not describe clearly the person's care, their preferences or reflect any changing need.”
criticalGovernance: “There were no established and effective processes in place to monitor and improve the quality of the service, ensure compliance with the regulations, or to reduce risk to people.”
criticalRecord keeping: “Some records were absent or incomplete. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
criticalStaff training: “The provider had failed to ensure staff had the appropriate training, skills to support people safely and in line with best practice and the law.”
criticalEnd-of-life care: “Most people were receiving end of life care and support. There was no care plan to support staff to respond to specialist support needed or any emerging need.”
criticalSafeguarding: “Risks associated to people's safety had not been considered...people who were at risk of falling or needed moving with equipment did not have suitable risk assessments.”
moderateStaff competency: “There was no evidence that they had completed any induction training or that their skills and experience had been assessed before starting work for the agency.”
moderateLeadership: “The service had lacked effective leadership. There were policies and procedure available...However, these had not been adapted or adopted into practice.”
moderateSupervision / appraisal: “Systems to capture feedback from staff had not been established. Supervision and team meetings were not used to capture staff views.”
Strengths
· Staff knew people well and provided attentive, personalised care; relatives praised staff as kind, caring and always having time for people.
· Staff proactively liaised with healthcare professionals including GPs, district nurses and hospice nurses to support people's health and wellbeing.
· People were supported to make their own choices and decisions in line with Mental Capacity Act principles.
· Staff demonstrated a strong team spirit and commitment to improving the service alongside the Nominated Individual.
· The Nominated Individual responded openly and transparently to inspection findings, produced an action plan and halted service expansion until leadership was established.
Quality-Statement breakdown (18)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires 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 working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control; end of life careRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: Meeting people's communication needsGood
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 empoweringRequires improvement
well-led: Duty of candour, continuous learning and improving care; working in partnershipGood