Halo Domiciliary Care's first CQC inspection rated the service Requires Improvement overall, with concerns around medicines administration records, inconsistent risk assessments, gaps in specialist staff training, and insufficiently embedded governance systems. Effective, caring and responsive domains were rated Good, reflecting consistent, person-centred care delivery, prompt complaint handling and good multi-agency working.
Concerns (6)
criticalMedication management: “staff were administering the medicines. No medicines administration record (MAR) charts were in place and there was a risk that staff would not administer the medicines safely.”
moderateCare planning: “Care plans for people who used a catheter or urostomy lacked sufficient detail to ensure consistent care and management of risks.”
moderateRecord keeping: “Not all people's risks had been consistently assessed. We found some people had detailed assessments for pressure ulcers and malnutrition, whilst other people's assessments lacked detail.”
moderateStaff training: “Staff had not always received training in the needs of the people who used the service, such as catheter, urostomy and dementia care.”
moderateGovernance: “systems and processes were in place to monitor the quality of the care provided; however, these had not always resulted in areas for improvement being identified and acted upon in a timely manner.”
minorSupervision / appraisal: “the manager had begun to implement observations and spot checks for staff, however few staff had received these. This meant the manager could not effectively monitor the care that staff were providing.”
Strengths
· People received their care calls on time and were supported by consistent staff who knew them well.
· Staff demonstrated good knowledge of infection prevention and control and had access to required PPE.
· Safe recruitment and selection processes were followed, including DBS checks for all employees.
· People and their relatives were involved in care planning and could access records electronically.
· Complaints were responded to promptly and improvements made, with extra training given to staff where needed.
Quality-Statement breakdown (22)
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: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceRequires 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
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 supportNot rated
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 staff, fully considering their equality characteristics; Continuous learning and improving careGood
well-led: How the provider understands and acts on the duty of candourGood