Date of Assessment: 4 to 23 December 2025. The service is a care at home service. It provides personal care to people living in their own homes. They supported adults with physical disabilities, including those living with dementia. At the time of the inspection they were supporting 4 people. An assessment has been undertaken of a specialist service that is registered for use by autistic people or people with a learning disability. At the time of the assessment, the service was not used by anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group. The provider was previously in breach of the legal regulation in relation to safe care and treatment and safer recruitment. The service had made improvements and was no longer in breach of these regulations. Recruitment processes had been reviewed and updated to ensure safer recruitment procedures were followed. People’s care plans and risk assessments had been updated to include more detailed information about their health conditions, with further guidance added for staff to help keep them safe. The management of people’s medicines had improved. Monitoring and quality assurance systems had been implemented to ensure they were more effective in identifying areas for improvement and improving people’s care. People were protected and kept safe. Staff understood people’s needs and managed any risks related to their care. There were enough staff with the right skills and experience. Staff had multiple shadowing opportunities and time to review people’s care records to fully understand their communication, personal and health needs. People and their relatives were involved in assessments of their needs and decisions about their care. The provider assessed and reviewed people's needs effectively with care and treatment planned and delivered in line with best practice and worked in partnership with the relevant professionals. People were treated with kindness and compassion and staff respected their privacy and dignity. Staff were able to build positive trusting relationships through continuity of care. They treated people as individuals and supported their preferences. Staff understanding of people's cultural requirements had positive benefits, as it helped to enhance communication, trust, and the overall level of care. Staff monitored people’s health to support healthy living and reported any changes in health and wellbeing in a timely manner. People received fair and equal care and treatment. People knew how to give feedback and were given regular opportunities to share their experiences of the care they received. People and their relatives were confident the service would take the appropriate action. The registered manager provided effective leadership, promoting a positive culture and encouraging staff involvement. The service supported staff wellbeing and considered any personal circumstances, which ensured staff felt valued and appreciated. The provider demonstrated a proactive and positive culture of safety, which ensured people were protected and kept safe. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Staff were confident in reporting concerns, knowing they would be addressed immediately. Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. The management team were open to feedback and further learning and improvement.
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Care Delivered Ltd, a small London domiciliary care agency, received an overall rating of Requires Improvement at its first inspection in September 2022, with regulatory breaches identified in safe care and treatment (Regulation 12) and fit and proper persons employed (Regulation 19). While the service demonstrated strengths in caring, responsiveness, and person-centred culture, risk assessments were inconsistent, recruitment checks were inadequate, and governance systems failed to identify these issues.
Concerns (7)
criticalCare planning: “care plans and risk assessments were inconsistent and did not always contain clear guidance for staff to ensure they understood how to mitigate known risks.”
criticalOther: “provider did not follow safe recruitment processes as they had not obtained a full employment history when recruiting new staff and gaps in employment were not explained.”
moderateRecord keeping: “one person's home safety checklist showed a walk-in shower had been provided. However, the personal hygiene part of the care plan still stated staff should support the person with a strip wash.”
moderateMedication management: “medicines support described in care plans were not in line with current best practice guidance... 'prompting' as a category of medicine support so we could not be sure whether the prompting was part of a self-management plan”
moderateStaff competency: “Some staff we spoke with told us they had not received MCA training and they could not describe how they applied the principles of MCA in their day to day role.”
moderateGovernance: “quality assurance processes in place but these were not always effective as they had not identified the issues with risk assessments and recruitment checks that we found.”
moderateStaff training: “training matrix showed that all staff had received MCA training the gaps in the staff knowledge showed the training had not been effective and further support and training was required.”
Strengths
· Sufficient numbers of suitably skilled staff to meet people's assessed needs, with no missed or late visits reported.
· Staff demonstrated good understanding of safeguarding and whistleblowing procedures.
· Effective infection prevention and control practices with appropriate PPE use confirmed by people receiving care.
· Person-centred culture praised by people and staff; provider went above and beyond, e.g. delivering water during hot weather.
· Provider worked well with other agencies including social workers and occupational therapists.
Quality-Statement breakdown (24)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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 dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
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 ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
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: 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 careGood