Mickle Hill, a small extra care domiciliary service, was rated Requires Improvement overall following a March–April 2023 inspection, a decline from its previous Outstanding rating under a prior provider. A breach of Regulation 17 was identified due to ineffective governance and inconsistent record keeping across risk assessments, care plans, and communication records, placing people at risk of harm.
Concerns (5)
critical
Record keeping
: “records used by staff as a point of reference about people's safety were not always consistent, accurate or up to date. This put people at risk of harm.”
criticalGovernance: “Governance and performance management was not always reliable and effective and had failed to ensure remedial actions for the concerns found during this inspection were implemented in a timely way. This was a breach of regulation 17(2)(b)(c)”
moderateCare planning: “Care records were not well organised and included important omissions and outdated information. There was no meaningful process to ensure support was responsive to meet people's needs.”
moderateCommunication with families: “the information was not always up to date and failed to record changes and deterioration in people's ability to communicate.”
minorPerson-centred care: “most people felt they did not have a say in who their carer's were and were not aware they could have a choice.”
Strengths
· People felt safe and staff were proactive in identifying ways to keep them safer; safeguarding training was in place and incidents were routinely investigated with lessons learnt.
· Medicines were administered safely with electronic MAR records checked for accuracy and PRN protocols in place.
· Safe recruitment practices were followed including DBS checks.
· Staff received relevant training, regular supervisions, and competency spot checks including medicines observations.
· People had good access to healthcare professionals and staff worked effectively with other agencies.
Quality-Statement breakdown (19)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
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
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; Supporting people to live healthier livesGood
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; Respecting privacy, dignity, and independenceGood
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Supporting people to avoid social isolation; support to follow interests and activitiesGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff clear about roles; quality performance, risks, and regulatory requirements; promoting positive cultureRequires improvement
well-led: Duty of candour; openness and honesty when things go wrongGood
well-led: Continuous learning and improving care; working in partnership with othersGood