Date of Assessment: 5th to 21st November 2024. The service is a care at home service providing support to adults of all ages living with dementia, mental health conditions, physical disabilities, learning disabilities or autistic spectrum disorder. People were supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported 32 people with personal care. This included 3 people with a learning disability. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. At our last inspection the service was in breach of regulations regarding staff training and governance. The service had made improvements and is no longer in breach of regulations. Managers now made sure staff received the training they required to carry out their roles and the provider had effective quality monitoring systems in place to identify and drive improvements. The service had a good learning culture and people could raise concerns. People were protected and kept safe. Staff understood and managed risks. Staff managed medicines well. Staff worked with all agencies involved in people’s care for the best outcomes. They monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people took decisions in people’s best interests where they did not have capacity. People were treated with kindness and compassion. People were involved in decisions about their care. Leaders and staff had a shared vision and culture based on listening, learning and trust. Staff felt supported to give feedback and were treated equally.
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Stokely Healthcare Ltd received an overall rating of Requires Improvement at its first CQC inspection, with regulatory breaches found in staff training and competency (Regulation 18) and governance (Regulation 17), including failures around DoLS and MCA compliance. Care delivery was consistently rated Good, with strong person-centred practice and positive feedback from people and relatives, but governance systems were insufficiently embedded to identify and address the risks inspectors found.
Concerns (6)
criticalStaff training: “Staff were not always supported to access training that was specific to peoples' support and health care needs. Not all staff had received training in catheter care.”
criticalStaff competency: “One of the assessments viewed had been completed by staff who had not received training themselves with this task.”
criticalConsent / capacity: “A mental capacity assessment and best interest decision had not been completed, and no consideration had been made in relation to deprivation of liberty safeguards (DoLS).”
criticalGovernance: “Governance systems were not always robust or effective and had not identified the shortfalls we found during the inspection.”
moderateRecord keeping: “Full employment histories were not always fully recorded. A number of forms viewed had been signed by people's relatives... no copies of the records to evidence the relatives who signed had legal authority.”
minorCare planning: “Some care plans lacked detail about people's individual needs.”
Strengths
· People and relatives consistently praised staff as kind, compassionate, respectful and patient.
· Sufficient staffing levels maintained, including through international recruitment, with no missed or late visits reported.
· Medication administration was thorough, with electronic MAR systems, risk assessments and competency checks in place.
· Person-centred care delivered in line with individuals' cultural, religious and communication needs.
· Effective safeguarding processes and staff knowledge of abuse reporting procedures.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentGood
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceRequires improvement
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: 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 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, quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood