Elmar Home Care Limited was rated Requires Improvement overall following an April 2018 inspection, with two regulatory breaches identified under Regulation 12 (medicines management) and Regulation 17 (governance). The service demonstrated caring practice and safe recruitment but failed to maintain consistent MAR completion, robust quality auditing, and adequate moving and handling training for staff.
Concerns (8)
critical
Medication management
: “MARs were not consistently completed with numerous gaps where we could not establish whether people had received their medicines as prescribed.”
criticalGovernance: “Systems and processes to assess, monitor and improve the quality and safety of the service were not sufficiently robust.”
moderateMedication management: “Medicines profiles did not always reflect people's current prescribed medicines.”
moderateRecord keeping: “MARs and daily records were not consistently brought back to the office on a regular basis. This meant timely checks and audits of these documents were not always completed.”
moderateStaff training: “Some staff had not received any practical training in how to operate moving and handling equipment such as stand-aids, hoists and slide sheets.”
moderateStaff competency: “At the time of the inspection, staff competency assessments had not been undertaken, although we saw a plan was in place to address this.”
minorEnd-of-life care: “We found a lack of information recorded in people's care records as to their end of life care needs and preferences.”
minorCare planning: “Care plans were subject to regular review to ensure they remained up-to-date. People and/or their relatives told us they had been involved with this process, although this was not formally documented.”
Strengths
· People told us they felt safe with staff and staff were described as kind, caring and respectful.
· Safeguarding policies were in place and staff had received training; concerns were appropriately referred to the local authority and/or police.
· Accidents and incidents were documented with clear investigations and lessons learned recorded.
· Safe recruitment procedures were in place including DBS checks, identity checks and references.
· Staff received regular supervision, spot checks and annual appraisals.
Quality-Statement breakdown (22)
safe: Medicines managementRequires improvement
safe: SafeguardingGood
safe: Risk assessmentRequires improvement
safe: Staffing and recruitmentGood
safe: Infection prevention and controlGood
effective: Mental Capacity Act / consentGood
effective: Staff trainingRequires improvement
effective: Supervision and appraisalGood
effective: Healthcare needs and professional liaisonGood
effective: Consistency of staffingRequires improvement
caring: Kindness and respectGood
caring: Privacy and dignityGood
caring: Involvement in care planningGood
caring: Cultural and communication needsGood
responsive: Person-centred care planningGood
responsive: End of life care planningRequires improvement
Elmar Home Care Limited was rated Inadequate overall following inspection in August 2016, with six regulatory breaches identified spanning medicines management, safeguarding, staffing, recruitment, complaints, and governance. The service was placed in Special Measures due to persistent failures — several of which, including unsafe medicines recording, had remained unresolved since the previous inspection in September 2014.
Concerns (14)
criticalMedication management: “MARs we reviewed were poorly completed and it was not clear what medicines had been prescribed or when they had to be administered.”
criticalSafeguarding: “one staff member who had worked in the service for two years told us they had received no safeguarding training and were unable to describe the different types of abuse.”
criticalMissed or late visits: “finish time at one call was the same as the start time at another, however, the calls were 3.8 miles apart and the AA route planner calculated this journey would take 13 minutes.”
criticalStaff training: “one care worker with no previous experience in care had not completed basic areas of training, such as food hygiene, safeguarding, infection control and first aid awareness, until after they had worked for the service for three months.”
criticalGovernance: “lack of strong leadership, ineffective quality assurance systems, weak communication and poor record keeping meant issues we found at this inspection had not been identified or resolved.”
criticalIncident learning: “person had fallen while staff had been present, the person had sustained a head injury and been admitted to hospital. There was no accident report for this incident.”
criticalCommunication with families: “next of kin had not been informed by the agency of the fall or that the person had been admitted to hospital.”
moderateSupervision / appraisal: “In one care worker's file we saw their last annual appraisal had been completed in September 2013.”
moderateComplaints handling: “complaints raised were not always dealt with appropriately or resolved. This was a breach of the Regulation 16 of the Health and Social Care Act 2008.”
moderateCare planning: “People's care records did not always fully reflect their needs... there was no evidence of this support being delivered.”
moderateRecord keeping: “registered manager told us they met with staff every Friday...but there were no minutes of their discussions.”
moderateConsent / capacity: “registered manager confirmed they had received training in the Mental Capacity Act 2005...they told us none of the staff had completed Mental Capacity Act Training.”
moderateStaffing levels: “Insufficient care staff were being deployed to ensure people's needs were met in a timely way.”
minorPerson-centred care: “lack of information about people's lives, preferences or interests in the care records we reviewed. Only one of the people we spoke with said they had been involved in reviews of their care plan.”
Strengths
· People and relatives spoke positively about care staff who were described as 'fantastic' and a 'nice group of people', praising their kindness and caring attitude.
· Effective systems were in place to ensure people's nutritional and healthcare needs were met, with staff responding appropriately to changing needs.
· Staff demonstrated knowledge of emergency procedures, including when to call ambulances and how to respond if unable to gain access to a person's home.
· Care files and associated records were stored securely at the office base with systems in place to dispose of confidential information.
· General risk assessments in relation to people's homes were in place covering safety and moving and handling.
Quality-Statement breakdown (16)
safe: Medicines managementInadequate
safe: Staff recruitmentInadequate
safe: SafeguardingInadequate
safe: Staffing levels and deploymentInadequate
safe: Risk assessmentRequires improvement
effective: Staff training and inductionInadequate
effective: Supervision and appraisalRequires improvement
Elmar Home Care Limited improved from Inadequate to Requires Improvement overall, exiting Special Measures, with caring rated Good and people reporting kind, consistent support. One regulatory breach remained regarding consent documentation (Regulation 11), and further embedding of improvements in governance, record-keeping and DBS renewal processes was needed.
Concerns (4)
criticalConsent / capacity: “The service were not able to evidence documentation that showed indicated people had legal powers to act and consent on people's behalf.”
moderateRecord keeping: “some records were without evaluation dates and records of staff signing to show their understanding of the care records.”
moderateGovernance: “we raised concerns with the registered manager about DBS checks not being re-checked during employment.”
minorIncident learning: “conclusions and outcomes were not routinely documented and the registered manager agreed this was an area for further improvement.”
Strengths
· People and relatives felt safe with staff and reported kind, caring treatment with respect for dignity and privacy.
· Medicines were managed safely and people received medicines as prescribed.
· Staff received regular training, supervision and on-site spot checks supporting consistent competency.
· Effective recruitment procedures were followed with relevant pre-employment checks completed.
· Staffing levels were appropriate with consistent staff allocation and no missed calls reported.
Quality-Statement breakdown (20)
safe: SafeguardingGood
safe: Risk assessmentsGood
safe: RecruitmentRequires improvement
safe: Medicines managementGood
safe: Staffing levelsGood
safe: Accident and incident recordingRequires improvement
Elmar Home Care Limited improved from Requires Improvement to Good overall following a change of provider and management team, with the previous breaches in medicines management and governance resolved. The service remains Requires Improvement for Safe due to ongoing gaps in MAR records, an absent diabetes risk management plan, and insufficient analysis of incidents and accidents.
Concerns (6)
moderateMedication management: “We found a number of gaps on medicine administration records (MARs) where we could not confirm if people had received their medicines as prescribed.”
moderateMedication management: “Some handwritten MARs were not signed by staff to confirm the prescription was correct.”
moderateCare planning: “one person who had diabetes and had a recent hospital admission due to low sugar levels did not have an appropriate risk management plan in place to help reduce the risk.”
moderateGovernance: “The management team recognised audits of the medicine management system needed to be more robust.”
minorIncident learning: “Accidents and incidents were recorded with action taken. However, further analysis was required to analyse themes and trends to mitigate the risk of reoccurrence.”
minorMissed or late visits: “staff apologised if they were late, but did not always phone to inform them.”
Strengths
· Safe recruitment procedures were in place with appropriate pre-employment background checks.
· Staff received a range of relevant training including a 12-week induction, regular updates, competency checks, appraisal and supervision.
· People's diverse communication needs were met, including care plans in audio, translated and easy-read pictorial formats.
· Strong person-centred approach with detailed care records reflecting individual preferences, interests and independence goals.
· Service liaised effectively with healthcare professionals including district nurses, GPs and occupational therapists.
Quality-Statement breakdown (21)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; consent to care and treatment in line with MCAGood
effective: Staff support: induction, training, skills and experienceGood
effective: Nutrition and healthcare support
Good
caring: Kindness and respect from staffGood
caring: Involvement in care decisionsRequires improvement
responsive: Care planningRequires improvement
responsive: Complaints handlingInadequate
well-led: Quality assurance and governanceInadequate
well-led: Record keepingInadequate
well-led: LeadershipInadequate
effective:
Requires improvement
effective: Nutrition and hydrationGood
effective: Healthcare accessGood
caring: Relationships and dignityGood
caring: Involvement in care planningGood
caring: Promoting independenceGood
responsive: Care planning and reviewsRequires improvement
responsive: Complaints handlingGood
responsive: Person-centred care deliveryGood
well-led: Governance and auditingRequires improvement
well-led: Leadership and cultureGood
well-led: Quality monitoring and feedbackGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to access healthcare servicesGood
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 meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Planning and promoting person-centred, high-quality care and openness; duty of candourGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood