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

Inspection report · 2023-02-08

Framework: KLOE · 8 pages · 71 KB · PDF

Inadequate

safe: Insufficient evidence to rate

This targeted inspection of Agincare Oxford (January 2023) found that the provider had met the Warning Notice for Regulation 12 (Safe Care and Treatment), demonstrating improvements in risk assessment, medicines management, and infection control. The overall rating remains Inadequate as the service continues to breach regulations relating to person-centred care, safeguarding, complaints handling, governance, and staffing identified at the previous comprehensive inspection.

Concerns (10)

criticalPerson-centred care: “The provider remains in breach of regulations found at the last inspection. These relate to person centred care, safeguarding people from abuse, receiving and acting on complaints, good governance, duty of candour and staffing.”
criticalSafeguarding: “The provider remains in breach of regulations found at the last inspection. These relate to person centred care, safeguarding people from abuse, receiving and acting on complaints, good governance, duty of candour and staffing.”
criticalComplaints handling: “The provider remains in breach of regulations found at the last inspection. These relate to person centred care, safeguarding people from abuse, receiving and acting on complaints, good governance, duty of candour and staffing.”
criticalGovernance: “The provider remains in breach of regulations found at the last inspection. These relate to person centred care, safeguarding people from abuse, receiving and acting on complaints, good governance, duty of candour and staffing.”
criticalStaffing levels: “The provider remains in breach of regulations found at the last inspection. These relate to person centred care, safeguarding people from abuse, receiving and acting on complaints, good governance, duty of candour and staffing.”
criticalMedication management: “One person's care plan contained conflicting information regarding the support they required with their medicines, this put them at risk of missing or receiving too much of their medicines.”
criticalCare planning: “People who received reablement care (short-term care after hospital stays) did not have risk assessment in place, this included general risk assessments and mobility risk assessment.”
criticalIncident learning: “At the last inspection, accidents and incidents were not documented, therefore action taken to assess the risk was not effective to ensure service users were kept safe.”
moderateInfection control: “At the last inspection we were told by one person using the service that topical medicines were not always applied with the correct use of PPE.”
minorRecord keeping: “For one person, information about their needs was not always consistent through their care plan. The manager told us they would take direct action to rectify this.”

Strengths

· Provider worked closely with the local authority's quality team and made improvements in risk assessment, staff training, guidance and medicine management.
· A risk tracker was implemented; accidents and incidents now documented with outcomes, lessons learned and actions taken.
· Reablement clients now have detailed risk assessments and care plans reviewed weekly.
· Body maps and updated MARs now detail topical cream application; senior staff conduct daily medicine chart and daily note checks.
· All staff retrained in PPE use; spot checks carried out to ensure correct PPE use during care delivery.

Quality-Statement breakdown (3)

safe: Assessing risk, safety monitoring and managementInsufficient evidence to rate
safe: Using medicines safelyInsufficient evidence to rate
safe: Preventing and controlling infectionInsufficient evidence to rate

Inspection report · 2022-10-25

Framework: KLOE · 24 pages · 115 KB · PDF

Inadequate

safe: Inadequateeffective: Requires improvementcaring: Requires improvementresponsive: Requires improvementwell-led: Inadequate

Agincare Oxford was rated Inadequate overall and placed in special measures, with six breaches identified including unsafe medicines management, failure to act on safeguarding allegations, inadequate risk assessments, insufficient staffing and training, poor complaints handling and ineffective governance. While people praised individual staff as kind and caring, leadership oversight, record keeping and duty of candour were significantly deficient.

Concerns (16)

criticalSafeguarding: “The service had failed to implement effective systems to identify, investigate and appropriately respond to allegations of abuse.”
criticalMedication management: “The service had not ensured the proper and safe management of medicines, including record keeping of the administration of medicines.”
criticalCare planning: “Risk assessments were either not present, had not been updated in a timely manner, or lacked sufficient detail to help staff understand and respond to risks.”
criticalGovernance: “The provider's systems and processes in place to assess, monitor and mitigate risks and to improve the quality and safety of the service were not always effective.”
criticalStaff training: “staff had not received training in; fluid and nutrition, MCA, dementia, food hygiene, safeguarding and infection prevention.”
criticalStaffing levels: “The registered person did not ensure there were sufficient numbers of staff deployed effectively to meet people's care and treatment needs.”
criticalIncident learning: “records did not include further investigation, analysis, action or outcome to consider how incidents occurred and steps taken to try to prevent a reoccurrence.”
criticalComplaints handling: “Systems were not operated effectively for identifying, receiving, recording, handling and responding to complaints.”
criticalPerson-centred care: “Processes for assessing and reviewing people's needs were not fully effective in ensuring care met people's needs and preferences.”
criticalRecord keeping: “People's care records were not up to date and did not reflect current care.”
criticalLeadership: “The registered manager did not have an adequate understanding of their role, regulatory requirements and lacked oversight of the service.”
criticalStaff competency: “Stoma care was being carried out by staff despite staff having not been trained.”
criticalOther: “The registered person did not follow and accurately record and keep a copy of all the actions taken as required in the regulation when a notifiable safety incident occurred.”
moderateSupervision / appraisal: “Staff members were not supported to reflect on their working practices through regular supervisions.”
moderateInfection control: “The provider did not have processes and systems in place to ensure that all staff met their responsibilities in relation to preventing and controlling infection.”
moderateMissed or late visits: “lots of lateness. I like to have my breakfast at 9am, sometimes they don't come until 11.30am”

Strengths

· Staff recruitment checks including DBS were carried out to protect people from unsuitable staff
· People and relatives gave good feedback about staff being kind, caring and respectful
· New staff received an induction and a period of shadowing more experienced staff before working alone
· Staff supported people to maintain their skills and abilities to live as independently as possible
· The provider worked in partnership with local GPs and health professionals from hospitals

Quality-Statement breakdown (22)

safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Staffing and recruitmentNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experience

Inspection reports (3)