ReadyCQC, a weekly field guide to CQC home-care regulation

criticalSafeguarding: “Where a whistle blowing concern had been raised about potential neglect, the provider had failed to follow procedures to safeguard vulnerable adults and there had been delay in reporting the concern to the relevant external agency.”
criticalConsent / capacity: “Decisions had been made on behalf of people who lacked capacity without the principles of the MCA having been followed. This included using surveillance equipment and administering medicines covertly.”
criticalStaff training: “The provider shared their training matrix which showed a significant number of staff had not received some training for over four years. This included mental capacity, infection control, fluid and nutrition, health and safety.”
criticalStaff competency: “Regular competency assessments were not taking place to ensure staff had the skills and knowledge to support people. Some staff hadn't had a medication competency completed for over four years.”
criticalGovernance: “Governance systems to ensure the safety and quality of the service were not robust. The telephone audit system introduced at the start of COVID-19 was still in place despite government guidance changes allowing visits.”
moderateIncident learning: “The provider had not taken enough action to share learning across the organisation and improve care following a safeguarding incident.”
moderateInfection control: “A large number of staff had not received Infection Prevention and Control training for over four years, and there were no competencies in place to ensure good practice in this area.”
moderateMedication management: “Where people needed their medicines 'as and when required' protocols required more guidance for staff to follow. The lack of guidance increased the risk of people not having their medicines when required.”
moderatePerson-centred care: “The service had not explored how to support people in the least restrictive way. One person was unable to access their kitchen due to identified risk. Alternatives had not been explored.”
minorRecord keeping: “Some care records contained unclear information. For one person who had a specialist health condition there was conflicting information about when the GP should be contacted.”

Inspection report · 2024-07-16

Framework: KLOE · 16 pages · 96 KB · PDF

Requires improvement

safe: Requires improvementeffective: Goodwell-led: Requires improvement

Sandwell Community Caring Trust improved from Inadequate to Requires Improvement overall, exiting Special Measures, with notable progress in safeguarding, consent and staff competency. However, continued breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) remain due to unsafe COVID-19 isolation practices and ineffective care record management.

Concerns (7)

criticalInfection control: “On two occasions staff who had tested positive for COVID-19 had continued to work and isolated with people in their own homes”
criticalGovernance: “Governance processes were not always effective to hold staff to account, keep people safe and provide good quality care and support.”
moderateCare planning: “Some care plans had more than one set of guidance for staff and the guidance was different with no date so it wasn't clear which one should be followed.”
moderateRecord keeping: “There was no effective system to check care records were up to date...care records included inaccurate and duplicate information and there were some gaps in monitoring records.”
minorMedication management: “One person had received an 'as required' medicine on a regular basis and staff had not asked the doctor for a review.”
minorStaff training: “Staff told us they had attended more specialised training...this information was not recorded on the provider's training matrix.”
minorCommunication with families: “Some relatives were not aware of the complaint's procedure or the management structure of the service.”

Strengths

· People were supported to pursue their interests including holidays, activities and social events, with staff enabling active community participation.
· Safeguarding improvements were sufficient to clear the previous breach of Regulation 13; staff demonstrated good knowledge of abuse recognition and reporting.
· Staff training and competency had improved significantly, clearing the previous breach of Regulation 18, with medicine competencies completed for all administering staff.
· Mental capacity and consent practice improved sufficiently to clear the previous breach of Regulation 11; staff demonstrated good understanding of decision-specific capacity.
· People and relatives gave overwhelmingly positive feedback about care quality: 'Couldn't wish for better care and service' and 'I would give 10 out of 10'.

Quality-Statement breakdown (14)

safe: Preventing and controlling infection; Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
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 law

Inspection reports (4)