Community Careline Services moved out of Special Measures with improved ratings of Good in effective, caring and responsive, but remained in breach of regulations 12 and 17 due to ongoing concerns with medicines management, risk assessments and governance oversight. The service was rated Requires Improvement overall, with recommendations on staff deployment and individualised care records.
Concerns (16)
critical
Medication management
: “MAR records did not always reflect all medicines people were prescribed... There was a risk medicines could be missed if MAR was not accurate.”
criticalMedication management: “Some MARs had different instructions to the medicine labels, on one occasion this had been discussed with the person but not their GP”
criticalCare planning: “Risks were not always fully assessed and managed... the information was basic and required more details and personalisation to manage these.”
criticalCare planning: “One record we reviewed had a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR)... However, there was no care plan or risk assessment to ensure staff had the guidance”
criticalGovernance: “Systems were not robust enough or established to ensure the oversight and good governance of the service. This placed people at risk of harm.”
moderateMedication management: “When paracetamol had been administered there was no record of the time recorded. This meant we were unsure if doses were sufficiently spaced with the required four-hour gap”
moderateGovernance: “The management team undertook regular monthly audits, however none of these issues had been noted which meant the audits were not effective.”
moderateMissed or late visits: “We received some feedback that visits were occasionally missed or late and people felt the service would benefit from more staff.”
moderateStaffing levels: “Careline (Community Careline services) is short of carers, if my regular carer can't come they don't let me know”
moderateRecord keeping: “we reviewed some of the daily records returned to the service from people's homes... However, the records were dated from February 2022.”
moderatePerson-centred care: “they were brief and lacked person centred information to support and guide staff to meet the needs of people.”
moderateCommunication with families: “If my regular carer can't come, they don't let me know. The office don't ring and they don't let you know”
minorLeadership: “There is a lack of management stability in the company.”
minorComplaints handling: “the records would benefit from more details about the concerns and the actions taken by the service. This would support improvements and lessons learned going forward.”
minorStaff training: “The training is all online. [There is] no face to face training, which is invaluable.”
minorIncident learning: “they would have benefited from more detail about the incident, and the incident had not been recorded on the incident log.”
Strengths
· Staff treated people with dignity and respect; positive feedback from people and relatives
· Staff understood safeguarding and had completed relevant training
· Infection control practices were effective with adequate PPE and competency checks
· Consent was sought and MCA principles followed
· Service worked in partnership with health professionals and accessed GP support
Quality-Statement breakdown (19)
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 abuse; Learning lessons when things go wrongNot rated
safe: Preventing and controlling infectionNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot 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 control and to meet their needs and preferences; End of life care and supportNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Continuous learning and improving care; duty of candourNot rated
well-led: Working in partnership with othersNot rated