Date of assessment: 17 September 2024 to 24 September 2024. We found one breach of the legal regulations in relation to governance. Governance systems had not either identified or promptly resolved the concerns we found at this assessment. These included in relation to the safe administration of people’s medicines, how effectively lessons were learned, consistency of care planning and required further development of some policies, such as those to safeguard people and staff. Some improvements had been made in how safe and effective the service was, but further development was still required to the way people’s safety was managed. However, staff were safely recruited and people were supported to have choice and control and people could give feedback on their care. Health and social care professionals gave us examples of good outcomes achieved by people as a result of the care provided by New Age Care. We have asked the provider for an action plan in response to the concerns found at this assessment. This service has been in Special Measures since 06 April 2023. The provider demonstrated improvements that have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
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New Age Care received an overall rating of Requires Improvement following a focused October 2023 inspection, remaining in special measures due to an Inadequate Well-Led rating and continuing breaches of Regulations 12 and 17. Persistent failures in medicines management, incomplete risk assessments, unreported safeguarding incidents, and ineffective governance audits were identified, with warning notices issued against both regulations.
Concerns (12)
criticalMedication management: “MAR did not always accurately record what doses people were administered or if those medicines were given in line with manufacturers guidelines.”
criticalMedication management: “One person was prescribed a pain-relieving medicine...MAR did not evidence that the required gap was consistently being maintained between doses.”
criticalMedication management: “Staff told us they crushed all medicines and gave with food, yet there was no instructions or guidance from a prescriber to ensure that those medicines were given safely.”
criticalSafeguarding: “In three examples, the provider failed to notify us of those incidents which was their legal responsibility.”
criticalGovernance: “Medicines audits were not always completed. Where those audits were completed, they failed to identify the issues we found.”
criticalIncident learning: “We identified 2 separate incidents that had not been captured in the provider's overall analysis of accidents and incidents.”
criticalIncident learning: “A serious injury was missed off July 2023 analysis. This meant the provider was not aware of all incidents to take appropriate steps to investigate.”
criticalLeadership: “There remained no effective system of continuous improvement. There was a lack of effective reporting, investigation and referral of serious concerns.”
moderateCare planning: “For one person with diabetes, there was no care plan which meant staff did not have important information to know how to manage any high or low blood sugars.”
moderateCare planning: “On 9 October 2023 the provider told us they had supported a person with personal care and a personal care plan needed to be completed...this had still not been completed.”
moderateConsent / capacity: “There was no formal assessment or best interest meeting to determine the best outcome for that person...staff deferred to family members instead of seeking that person's consent.”
moderateRecord keeping: “Some MAR had gaps which meant we could not be sure those people had been given their medicines as prescribed.”
Strengths
· People and relatives spoke highly of the service and reported good relationships with consistent care staff.
· Staffing levels were adequate and people confirmed calls were not missed; late calls were communicated in advance.
· Safe recruitment practices had improved, including DBS checks and written references.
· A dedicated training lead was recruited to develop the training programme and embed learning through spot checks.
· Staff supported people to access healthcare services and worked effectively with GPs, community nurses and local authorities.
Quality-Statement breakdown (16)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
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 lawRequires improvement
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
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Working in partnership with othersGood
well-led: Engaging and involving people using the service, the public and staffGood
New Age Care received an Inadequate overall rating following a focused inspection of Safe and Well-Led, with continuing breaches of Regulations 12, 17, 19, and 20A, including wholly absent recruitment checks for one staff member, ineffective medicines management, and no functioning quality assurance system. Despite staff being valued by people and families, the provider failed to sustain any improvements since the previous Requires Improvement rating, resulting in the service being placed in special measures.
Concerns (10)
criticalMedication management: “Medicine Administration Records (MAR) did not always correlate with people's care plans. It was not always clear what medicines a person had been prescribed or if staff administered them.”
criticalCare planning: “One person had diabetes. There was no diabetes risk assessment or care plan to direct staff on how to identify concerns relating to safe diabetes practices.”
criticalStaff competency: “The provider told us about one staff member who worked under the identity of another person. There were no records to support safe employment checks were completed at all.”
criticalGovernance: “Checks we would expect to be made such as late/missed calls, daily log completion, medicines management, care plans and risk assessments were non-existent.”
criticalSafeguarding: “Staff lacked confidence to share their concerns with the provider...staff shared information with us about specific examples that should have been referred to the local safeguarding team.”
criticalLeadership: “"I haven't had any oversight. I haven't been on it (quality assurance) because I thought other people were. I accept the responsibility."”
moderateRecord keeping: “There was a lack of order in record keeping and some documents, audits and checks we asked for could not, or were not, made readily available to us.”
moderateIncident learning: “The provider was not able to demonstrate an effective system for overseeing incidents and accidents to identify any themes or trends, reduce the risk of reoccurrence.”
moderatePerson-centred care: “There was no formal process for people and relatives to provide their feedback about the service. Some relatives told us...their concerns and opinions went unheard.”
moderateCommunication with families: “When things did not go to plan, relatives said there was no explanation or apology given. This happened frequently when staff were swapped last minute.”
Strengths
· People and relatives were pleased with care staff and reported positive relationships with a regular staff team who knew them well.
· Staff understood their safeguarding responsibilities and could explain how to report concerns externally if needed.
· Staff had access to PPE and people and relatives were satisfied with infection control practices.
· Office staff and the provider covered care calls during the inspection to ensure continuity of care.
· People confirmed they received care at the right times and were notified when calls were running late.
First inspection of New Age Care identified breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance), with risk management plans, care plans and audit systems failing to identify or address issues including an unapproved moving and handling technique. Effective, caring and responsive domains were rated Good, supported by safe recruitment, trained staff and positive feedback from people and relatives.
Concerns (9)
criticalCare planning: “we found risk management plans were not always updated to reflect changes in people's needs and abilities. Gaps in risk assessment tools in some care plans”
criticalStaff competency: “we found staff did not always use the hoist from the commencement of this person's care. Instead, staff used an unapproved technique which had potential to cause this person serious harm.”
criticalGovernance: “The provider did not demonstrate effective governance, including assurance and auditing systems or processes. This was a breach of Regulation 17”
criticalLeadership: “There was no effective leadership or accountability to resolve this in a timely way to promote a good outcome for this person.”
moderateCare planning: “in each of the care plans we reviewed; those plans lacked detail especially when those needs had changed”
moderateMedication management: “where people had medicines administered by staff on an 'as needed' basis, there were no 'as and when' protocols to tell staff, when and how to give those medicines.”
moderateIncident learning: “there was no recorded analysis of those incidents to identify any patterns or trends to mitigate similar incidents from reoccurring.”
moderateCommunication with families: “staff lacked confidence in communicating with management about issues or concerns they had. Staff told us when they had raised concerns, these were not acted upon.”
moderateRecord keeping: “the registered manager told us they thought their own paperwork and records would let them down because they were not thorough enough.”
Strengths
· Safe recruitment practices including DBS checks and references completed prior to staff commencing
· People and relatives reported staff turned up on time and stayed the correct length of time for each call
· Continuity of care maintained, with same staff supporting 24/7 live-in clients for several weeks
· Staff trained to recognise signs of abuse and aware of safeguarding responsibilities
· Staff followed infection prevention guidance with plentiful supply of PPE
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
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
effective: Ensuring consent to care and treatment in line with law and guidanceGood
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: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement