Classic Home Care Services Limited was rated Requires Improvement overall at its May 2019 inspection, with one regulatory breach (Regulation 11 – Need for Consent) due to failures in applying the Mental Capacity Act and inadequate medicines management, including absent PRN protocols and risk assessments. Caring and Responsive were rated Good, reflecting a compassionate, person-centred workforce, but governance and audit processes were insufficient to detect and remedy safety and care-planning shortfalls.
Concerns (6)
criticalMedication management: “Risk assessments were not in place when medicines were left out, protocols were not in place for the use of 'as required' medicines and MAR charts had not consistently been amended following changes in prescribing instructions.”
criticalConsent / capacity: “Where relatives had signed people's care plans, the provider had failed to determine if they had the appropriate legal authority to do so, such as lasting power of attorney for health and welfare.”
moderateCare planning: “Specific risk assessments were not in place around how to safely manage the person's care and how to mitigate any risks of infection control when providing catheter or PEG care.”
moderateGovernance: “Audits were undertaken on a regular basis, however, these failed to identify shortfalls. MAR charts were checked on a monthly basis but failed to identify that the management and recording of medicines was not consistently in line with best practice.”
moderateRecord keeping: “One person's MAR chart identified they were required to use a nebuliser. Their care plan referred to them requiring a nebuliser but failed to explain why and how to safely support the person.”
minorIncident learning: “Since January 2019, the service had experienced two missed calls. The missed calls had not recorded or reported as incidents.”
Strengths
· Care workers treated people with dignity and respect, encouraging independence; people and relatives spoke highly of their kindness and compassion.
· Safe recruitment practices in place with full employment checks, references and DBS checks completed before staff started.
· Strong focus on staff training and competency assessment, including shadowing, regular supervision every three months and yearly appraisals.
· Complaints policy accessible to people; relatives and people felt confident raising concerns and 11 complaints since January 2018 were reviewed for trends.
· Person-centred approach with care plans reflecting individual interests, hobbies and aspirations, and staff going above and beyond care plan tasks.
Quality-Statement breakdown (21)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
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 controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support with openness; duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; working in partnership with othersGood
Classic Home Care Services Limited improved from Requires Improvement to Good across Safe, Effective and Well-led following a focused inspection on 14 January 2021, having resolved a previous breach of Regulation 11 (Need for Consent) and made demonstrable improvements to medicines management, risk assessment and governance. People and relatives consistently reported feeling safe, well-supported and satisfied with the quality and management of the service.
Strengths
· Provider introduced electronic Medication Administration Record (eMAR) system improving medicine management and reducing error risk
· Robust and individual COVID-19 risk assessments in place for each person, with adequate PPE stock and regular staff testing
· Improved compliance with Mental Capacity Act 2005, including decision-specific capacity assessments and legal authority documentation
· Consistent, regular staff who are well trained with competency checks and supervision confirmed by people and relatives
· Strong governance with audits across care records, medicines, safeguarding and incidents driving continuous improvement
Quality-Statement breakdown (15)
safe: Using medicines safelyGood
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
Classic Home Care Services Limited received a Good rating across all five key questions at its November 2016 inspection, demonstrating safe care with robust risk management, medicines oversight, and staff training. The only minor gap identified was a lapse in regular staff meetings due to recent management team changes.
Concerns (1)
minorGovernance: “we saw that there had not been any recent staff meetings...it had been difficult to organise staff meetings recently due to the changes in the management team”
Strengths
· Risks to people's safety and wellbeing were assessed with detailed plans in place for all identified risks
· People received care from regular care workers, enabling rapport and trusting relationships
· Medicines management was robust with regular audits, MAR charts completed with no gaps, and yearly refresher training for all care workers
· Staff received thorough induction including Care Certificate, shadowing, and competency assessments before unsupervised working
· Regular supervision every three months, annual appraisals, and unannounced spot checks were in place for all care workers
effective: Staff support: induction, training, skills and experience
Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; Working in partnership with othersGood