Charmes Care, a domiciliary care agency on the Isle of Wight, was rated Requires Improvement overall following a focused March 2023 inspection of the Safe and Well-Led domains, with breaches identified under Regulations 13 (safeguarding), 17 (governance) and 18 (staffing). Key failures included unreported safeguarding concerns, insufficient travel time allocation causing late and shortened care visits, inadequate PRN medicines guidance, and ineffective audit systems that failed to identify these risks.
Concerns (8)
criticalSafeguarding: “we found 4 occasions where CQC had not been notified of safeguarding concerns, 3 of which had also not been shared with the local authority safeguarding team.”
criticalStaffing levels: “one staff member visited 9 people over the course of their shift, where no travel time was allocated. The average travel time accumulated was 58 minutes.”
criticalGovernance: “Audits being completed had not identified the concerns we found during our inspection... no overall auditing process to identify if staff arrived on time.”
moderateMedication management: “Where people were prescribed 'as and when required' medicines to be taken up to 4 times a day, there was not always a 4-hour gap in between staff administering them.”
moderateCare planning: “People's care plans did not always contain enough information for staff to understand how to mitigate risks... other identified risks lacked sufficient detail.”
moderateMissed or late visits: “They are supposed to be here for an hour, but I never get an hour... They can be up to an hour and a half late sometimes.”
moderateCommunication with families: “I have called [the office] several times, but nothing gets done... If I ring [the office] and complain it doesn't go anywhere.”
moderateIncident learning: “they had failed to identify where some incidents or concerns raised, were safeguarding and further action was required to ensure people were safe.”
Strengths
· People's care plans were up to date and contained person centred information.
· Staff had received training in safeguarding and medicines administration with competency assessments completed.
· Safe and effective recruitment practices were followed.
· Electronic medicines administration records (MAR) and topical cream records (T-MAR) were used.
· Staff had access to PPE and infection prevention and control policy was up to date.
Quality-Statement breakdown (10)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
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 empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersGood
Charmes Care, a domiciliary care agency on the Isle of Wight supporting 39 people, was rated Requires Improvement overall, with shortfalls in medicines records, risk assessments and governance systems, as well as staff feeling undervalued and reporting insufficient travel time. Effective, caring and responsive domains remained Good, with positive feedback on person-centred care, recruitment, training and partnership working.
Concerns (9)
moderateMedication management: “some paper records lacked details of the specific dose that had been administered. This meant there was not a clear record of how much medicine the person had received”
moderateMedication management: “some staff lacked access to the electronic administration records (e-MARs) and therefore unable to monitor previous electronic administration records”
moderateCare planning: “one person had a catheter in place and another person was diagnosed with diabetes. There were no risk assessments in place for these conditions”
moderateGovernance: “some systems in place to assess, monitor and improve the quality of the service had not been effective. Both the registered manager and senior management team had failed to identify”
moderateStaffing levels: “five out of the seven staff spoken with felt this travel time was not always sufficient... I do feel I have to rush the care calls at times which really upsets me.”
moderateLeadership: “staff told us they felt undervalued and not listened to by the senior management team.”
moderateRecord keeping: “lack of robust systems in place for monitoring and reviewing people's paper records. This meant there may be a delay in identifying concerns or issues”
minorMissed or late visits: “There was one incident when the carer forgot about me. I rang the office and they made sure they came around.”
minorCommunication with families: “The outcome of these surveys were not reflected on in the Monthly Auditing Report' for October 2021 and there was no evidence available which demonstrated people's views or concerns had been acted on”
Strengths
· Safe and effective recruitment practices with all required pre-employment checks completed
· Staff treated people with kindness, dignity and respect; positive feedback from people, relatives and professionals
· Person-centred care plans reflecting individual needs, preferences and protected characteristics
· Robust complaints procedure with timely investigations and actions
· Effective infection prevention and control arrangements with appropriate PPE and COVID-19 guidance
Quality-Statement breakdown (22)
safe: Using medicines safelyNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Not rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; supporting people to access healthcare servicesNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and controlNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
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 requirementsNot rated
well-led: Engaging and involving people using the service, the public and staff; promoting a positive cultureNot rated
well-led: Continuous learning and improving careNot rated
well-led: Working in partnership with othersNot rated