Country Carers Limited, a domiciliary care agency supporting 38 people in Rye and surrounding rural areas, was rated Good across all five key questions at this February 2020 inspection. The service demonstrated person-centred care delivery, a consistent and well-trained staff team, robust quality assurance systems, and had successfully addressed previous shortfalls in mental capacity documentation since the last inspection.
Concerns (1)
minor
Medication management
: “After a number of documentation errors had been identified during monthly audits, a robust action plan had been implemented to address these errors.”
Strengths
· Consistent core team of staff providing continuity of care, with people and families speaking highly of the service
· Robust recruitment, induction, training, supervision and appraisal processes in place for all staff
· Person-centred care planning with regular reviews, involving people and relatives in decisions
· Strong quality assurance systems including audits, spot checks and home visits to monitor standards
· Effective multi-agency working with district nurses, GPs, occupational therapists and other healthcare professionals
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safely; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
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 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
caring: Ensuring people are well treated and supported; respecting equality and diversity; Respecting and promoting people's privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
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: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Managers and staff being clear about their roles, and understanding 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 care; Working in partnership with othersGood
Country Carers Limited was rated Good overall following significant improvements since a 2015 breach of Regulation 17, with strengthened governance, medicines management, care planning and recruitment practices. The sole area requiring improvement was the inconsistent application of the Mental Capacity Act, with capacity assessments not routinely completed for people living with dementia.
Concerns (2)
moderateConsent / capacity: “The provider did not have a consistent approach to assessing people's the mental capacity. Care documentation did not consistently identify how best interest decisions had been reached and who had been involved.”
moderateCare planning: “The provider had not routinely completed capacity assessments; however care and support was being provided to people who were living with dementia type illness.”
Strengths
· Medicines managed safely with robust audit systems; improvements since previous inspection in MAR record-keeping.
· Safe recruitment practices followed including DBS checks, employment references and previous employment histories.
· Sufficient staffing levels determined through individual needs assessments and reviewed with changes in need.
· Staff received regular training, supervision on a rolling three-month basis, and annual appraisals with spot checks.
· Care plans improved since last inspection with greater detail and individualised guidance for staff.
Quality-Statement breakdown (18)
safe: Medicines managementGood
safe: SafeguardingGood
safe: Risk assessmentGood
safe: Staffing levelsGood
safe: Recruitment practicesGood
effective: Mental capacity and consentRequires improvement
Country Carers Limited was rated Requires Improvement overall following a December 2015 inspection, with a breach of Regulation 17 identified due to inadequate quality assurance systems that failed to detect gaps in medicines administration records, task-focused care plans, and incomplete staff training records. Caring was rated Good, reflecting positive feedback about staff compassion, dignity, continuity and responsiveness to people's preferences.
Concerns (11)
criticalMedication management: “We looked at peoples medication administration records (MAR) and found three had multiple gaps...the gaps in the MAR meant they may not have received their medicines correctly”
criticalGovernance: “The issues identified with governance are a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
criticalIncident learning: “We identified a recent safeguarding incident which had not been notified to us; however the service had notified the Local Authority.”
moderateMedication management: “care staff were placing medication for one person into a pill pot so they could take them whilst they were at a day centre. The providers policy stated, 'care staff must not put out individual doses'”
moderateGovernance: “There was no system in place to record or collate late or missed care calls...no system for trends to be identified or to evidence staff learning from these.”
moderateRecord keeping: “people's most recent MAR documents to return to the office were dated July 2015, this delay meant any meaningful audit process to highlight concerns in a timely manner would be missed.”
moderateCare planning: “Care plans focused on the specific tasks care staff were required to undertake...had limited reference to a person centred care approach.”
moderateCare planning: “one person's risk assessment identified that they were living with diabetes however there was no reference to this within their care plan.”
moderateStaff training: “two new starters induction paperwork was not complete and neither the provider nor personnel manager could confirm what aspects of their induction they had completed.”
moderateSafeguarding: “one staff member was unsure of who to report suspected abuse to other than 'the manager'...another...had not had their safeguarding training refreshed yet had been back for five months.”
moderateLeadership: “The provider had failed to keep their registration updated correctly...registered to provide two regulated activities however they were only providing one of these.”
Strengths
· People felt safe and trusted staff; 100% of pre-inspection survey respondents said they felt safe using the service.
· Robust recruitment and DBS checks were in place before staff began work.
· Regular supervision on a rolling three-month basis with spot checks; staff felt well supported.
· Staff demonstrated compassion, dignity and respect; people described staff as kind, thoughtful and reliable.
· Continuity of care was prioritised, including a small dedicated team for people receiving palliative care.
Quality-Statement breakdown (19)
safe: Medicines managementRequires improvement
safe: SafeguardingRequires improvement
safe: Staffing levels and recruitmentGood
safe: Risk assessmentGood
effective: Staff training and inductionRequires improvement
effective: Supervision and appraisalGood
effective: Mental Capacity Act and consentGood
effective: Nutrition and hydrationGood
effective: Nutrition and hydration support
Good
caring: Kindness and compassionGood
caring: Privacy, dignity and independenceGood
caring: Involvement in care decisionsGood
responsive: Care planning and reviewGood
responsive: Complaints handlingGood
responsive: Missed or late visitsGood
well-led: Governance and quality assuranceGood
well-led: Leadership and cultureGood
well-led: Staff engagementGood
caring: Dignity, respect and compassion
Good
caring: Involvement in care planningGood
caring: Confidentiality and privacyGood
responsive: Care planningRequires improvement
responsive: Missed or late visitsGood
responsive: Complaints handlingGood
responsive: End of life careGood
well-led: Governance and quality assuranceRequires improvement