New Dawn Healthcare deteriorated from Good to Requires Improvement, with five regulatory breaches identified covering safe care and treatment, person-centred care, consent, governance, and operating from an unregistered location. Key risks centred on inadequate risk assessments, unsafe medicines management, non-person-centred care plans, absent capacity assessments, and ineffective quality assurance systems.
Concerns (10)
criticalMedication management: “Medicines were not always administered safely. The registered manager told us they only 'Prompted people to take medication'. There was no information within the provider's medicine policy”
criticalCare planning: “Care plans did not always contain up to date information on people's personal circumstances...Care plans did not have photos, or details of people's individual preferences.”
criticalConsent / capacity: “The provider had not always completed capacity assessments for people whose capacity to consent was in doubt. This was a breach of Regulation 11”
criticalGovernance: “Quality assurance systems such as audits were not being operated effectively...the provider's monitoring systems had failed to identify the concerns we found in relation to assessing risk and medicines management.”
criticalPerson-centred care: “The lack of person-centred care plans placed people at an increased risk of not having their needs met. This was a breach of regulation 9 of the Health and Social Care Act 2008”
criticalLeadership: “The provider was not operating in line with their registration...the NI informed us they were not at the registered location as they had moved offices. They had not informed CQC.”
moderateRecord keeping: “Accurate, complete and contemporaneous care records were not always maintained. Care plans and risk assessments were not audited to check that they contained all correct information.”
moderateMissed or late visits: “Over 41% of calls were less than half the planned time and some people were receiving their care calls later than agreed.”
moderateSupervision / appraisal: “Staff supervision was however ad hoc and staff meetings did not happen regularly, one staff member said, 'I can't remember the last time that we had a staff meeting'”
moderateInfection control: “The NI was unable to provide us with any infection control audits that were carried out during the COVID-19 pandemic for staff or people using the service.”
Strengths
· Recruitment procedures were robust, with authenticated references, proof of identity, right to work checks and DBS checks obtained for all staff.
· Staff were kind and caring; relatives described them as 'like fresh air' and noted they had developed good long-term relationships with people.
· Staff received safeguarding training and understood how to report concerns; safeguarding was discussed during staff meetings.
· Staff had access to appropriate PPE to help prevent the spread of infection.
· The provider understood their duty of candour and notified appropriate agencies when things went wrong.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
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 dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
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 meet people's needs, preferences, interests and give them choice and controlRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Continuous learning and improving careRequires improvement