Kalcrest Care (Northern) Limited was rated Inadequate overall and placed in special measures following a October 2016 inspection, with widespread breaches of regulation across medicines management, staffing levels, missed/late visits, care planning, record keeping, complaints handling, and governance. The absence of a registered manager and two care co-ordinator vacancies compounded systemic failures that left 183 people at risk of harm.
Concerns (14)
criticalMedication management: “MARs were in place. However those we reviewed were poorly completed and it was not clear what medicines had been prescribed or when they had to be administered.”
criticalStaffing levels: “There were insufficient staff deployed to ensure people received a consistent and reliable care service.”
criticalMissed or late visits: “Most people and relatives (24 out of 34) said that timekeeping was poor and staff didn't arrive on time and/or stay for the correct amount of time.”
criticalCare planning: “Some people were without complete care plans. There was a lack of information recorded on how staff should manage people's emotional and psychological needs.”
criticalRecord keeping: “We uncovered some evidence of false record keeping when reviewing timesheets and daily records. One care staff had written they had attended two different addresses for the same 30 minute period.”
criticalGovernance: “We identified several breaches of regulation and examples of poor service delivery which should have been prevented by robust systems of quality assurance and governance.”
criticalComplaints handling: “We found many of these issues with timeliness and record keeping had not been fully resolved despite some being raised as early as February 2016.”
criticalSafeguarding: “We saw information in people's records or from incident forms where CQC had not been informed of safeguarding concerns, including alleged physical abuse and suspected financial abuse.”
criticalLeadership: “A registered manager was not in place. The last manager deregistered in July 2016. There were also two care co-ordinator vacancies.”
moderateSupervision / appraisal: “During the inspection, the provider told us they were reinstating supervisions and appraisals since we saw many were out of date.”
moderateStaff training: “The provider did not have an up-to-date training matrix in place. Due to this it was difficult to see where training had lapsed.”
moderateIncident learning: “There was nowhere on the form to record the outcome, actions taken or lessons learned as a result. Some accidents/incidents had not been recorded in the accidents file.”
moderateCommunication with families: “People told us staff were often late and they were often not informed of this. Booked for 7 o clock, but the office starts at 9 o clock so there is no-one to contact when they are late.”
moderatePerson-centred care: “There was a lack of information within care records demonstrating an assessment of people's emotional and psychological needs, how to meet them and manage refusals of care.”
Strengths
· Most people said they felt safe in the company of staff and described care staff as kind, compassionate, respectful and polite.
· Safe recruitment procedures were in place including DBS checks and written references before staff commenced work.
· Staff had received training in key areas such as first aid, dementia, moving and handling, medicines administration, infection control and safeguarding adults.
· Regular staff demonstrated good knowledge of their clients' needs and built positive relationships.
· The provider and management were open and honest with inspectors about challenges and committed to improvement.
Kalcrest Care (Northern) Limited improved from Inadequate to Requires Improvement across all five domains following exit from Special Measures, with three remaining regulatory breaches relating to medicines management (Reg 12), person-centred care/care planning (Reg 9), and governance/record keeping (Reg 17). While staffing, rotas, safeguarding, and staff values showed meaningful progress, medication records contained significant errors, numerous care plans remained out of date, and quality assurance audits failed to detect the issues identified during inspection.
Concerns (10)
criticalMedication management: “one just stated 'Paracetamol' with no details of the strength, how many tablets could be administered, the frequency they could be given or the maximum number”
criticalMedication management: “care workers had signed the MAR on eight occasions to confirm this medicine had been given, with only one of these dates being a Sunday”
criticalRecord keeping: “Records relating to people's care and support were not consistently completed. Systems to ensure compliance with the regulations were not sufficiently robust.”
criticalCare planning: “one person lived with epilepsy and the care plan stated if they had a seizure for more than five minutes staff should call 999. This had been written in September 2013”
criticalGovernance: “medication administration records were being audited when returned to the office. However, we concluded these were not effective as they had not picked up the issues we identified”
criticalPerson-centred care: “Care was not always appropriate and did not always meet people's needs or preferences. A full assessment of people's needs had not always been carried out.”
moderateMissed or late visits: “morning call had on occasion varied between 08:00 and after 10am and their evening call 19.30 one day and 21.20 the next day”
moderateCommunication with families: “a number of people reported they were not always introduced to new care and support workers and did not know who was coming”
moderateComplaints handling: “two of these had not been logged and had then later come to the service as more formal complaints”
moderateSupervision / appraisal: “some staff had not received supervision for several months and some were yet to complete an appraisal. The registered manager...was unable to locate the documentation”
Strengths
· Robust and safe recruitment procedures in place, including DBS checks, written references and documented interview notes.
· Staff received a wide range of relevant training including dementia awareness, MCA/DoLS, end of life, medicines administration and service-specific topics.
· Safeguarding incidents were reported, investigated and acted upon appropriately, including disciplinary action where poor practice was identified.
· Financial transaction records were well completed, providing a full audit trail and reducing risk of financial abuse.
· Rotas improved with realistic scheduling and allocated travel time, leading to staff spending appropriate time with people.
Quality-Statement breakdown (18)
safe: Medicines managementRequires improvement
safe: Staffing levels and deploymentRequires improvement
safe: Risk assessmentsRequires improvement
safe: SafeguardingGood
safe: RecruitmentGood
effective: Staff training and competencyRequires improvement
effective: Supervision and appraisalRequires improvement
Kalcrest Care (Northern) Limited improved from Requires Improvement to Good overall, resolving previous breaches relating to safe care, person-centred care and governance. The single remaining area for improvement was call time consistency, with some people experiencing significant variation in visit times and no agreed call windows documented in care plans.
Concerns (4)
moderateMissed or late visits: “one person's morning call had varied between 7am and 10am for a period of time in May 2018 and another person's afternoon and evening calls were too close together.”
moderatePerson-centred care: “there was no agreed call times within people's care and support plans. One person...was not getting calls at the times they wanted them and had been unclear what the agreed call time was.”
minorStaff training: “one new staff member with previous experience had started work without shadowing, instead working as the 2nd staff member on a double up call.”
minorStaffing levels: “one of the rounds had issues with continuity of staff due to staff vacancy, staff annual leave and sickness.”
Strengths
· People felt safe and staff treated them with dignity, respect and kindness; positive feedback was widespread across 16 service users and 6 relatives.
· Medicines were safely managed with clear MAR records, regular audits, and staff competency assessments; improvements made since the previous inspection.
· Risk assessments were person-centred, up to date and detailed, covering pressure damage, moving and handling, bed rails and living environment.
· Safe recruitment procedures were in place including background, identity and work history checks.
· Staff received a broad range of training including Care Certificate, level 2/3 qualifications, supervision and appraisals.