This focused inspection of First Call Healthcare Limited, a domiciliary care service in Gateshead, checked whether a previously identified breach of legal requirements regarding medicines management had been remedied. The provider had followed its action plan and medicines arrangements were found to be sufficiently improved, though the 'safe' rating remained 'Requires improvement' pending evidence of consistent good practice over time.
Concerns (2)
criticalMedication management: “Staff had not had their competency to handle medicines fully assessed and there was a lack of clear information about current medicines and the support that people required.”
criticalRecord keeping: “Medicines administration records (MARs) were inaccurately completed and there was no system of auditing the MARs to identify any errors or shortfalls in recording.”
Strengths
· Provider followed their action plan and implemented further training for staff in the practical aspects of administering medicines and completing associated records.
· Medicines competency assessment with a comprehensive knowledge test introduced and completed with staff every six months.
· MARs returned to the office monthly for auditing; audits identified no discrepancies.
· Some staff trained and assessed in administering medicines via percutaneous endoscopic gastronomy (PEG).
· Observations of practice conducted during spot checks to ensure staff followed medicines procedure.
First Call Healthcare Limited was rated Good overall at its June 2016 inspection, with a single Requires Improvement rating in Safe due to a regulatory breach (Regulation 12) concerning inaccurate medicines administration records and absence of MAR auditing. All other key questions were Good, with particular strengths in personalised, caring relationships and responsive, well-led management under a newly appointed manager.
Concerns (7)
criticalMedication management: “staff had signed four times a day for a medicine that was only to be given in the mornings. An incorrect code had also been used in the MARs”
criticalMedication management: “lists of people's current medicines were not in place and medicines administration records (MARs) had not always been accurately completed”
criticalSafeguarding: “three allegations of neglect in recent months which had involved care and support visits being missed...safeguarding issues were reported retrospectively during the inspection”
moderateStaff competency: “there was no means of ensuring a full assessment of each staff member's competency was carried out”
moderateRecord keeping: “There was no current system for auditing the MARs and we concluded that people could not be fully assured of receiving their medicines safely.”
moderateSupervision / appraisal: “The manager acknowledged individual supervision for staff had lapsed prior to them being in post”
minorStaff training: “no training had been provided for staff in the MCA to make sure they understood the implications for their practice”
Strengths
· People and relatives consistently described staff as caring, respectful of dignity and privacy, and personalised in their approach.
· Sufficient staffing capacity in place with robust pre-employment checks including DBS, references, and values-based interviews.
· Care plans were personalised, agreed with people and their families, and kept under review at six-weekly and six-monthly intervals.
· Strong end-of-life care support, including coordinated working with palliative care nurses and emotional support for staff following bereavement.
· New manager provided strong leadership, improving supervision schedules, staff surveys, communication, and quality monitoring systems.
First Call Healthcare Limited is a domiciliary care agency rated Good across all five key questions at its January 2019 inspection, with people and relatives highly complimentary about kind, consistent, and well-organised care. Minor shortfalls were identified in care plan detail, food preference recording, MCA training depth, and audit oversight documentation, all of which the registered manager committed to address.
Concerns (4)
moderateCare planning: “Care plans did not all show steps to take to mitigate risk where it had been identified. For example, a risk of falls or distressed behaviours.”
moderateGovernance: “A formal system was not in place to check that identified actions were carried out and to audit the registered manager's audits.”
minorRecord keeping: “Information about people's food likes and dislikes was not available. The registered manager told us this would be addressed.”
minorConsent / capacity: “We discussed this should be a separate, in-depth course and not just as part of the Care Certificate.”
Strengths
· People felt safe and trusted staff; sufficient staffing levels maintained with flexible roles
· Staff knowledgeable about safeguarding and knew how to report concerns
· Effective medicines management with regular training and competency assessments
· Kind and compassionate care with strong person-centred ethos reported by people and relatives
· Staff introduced to people through shadowing before providing care independently