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

Inspection report · 2022-12-31

Framework: KLOE · 11 pages · 82 KB · PDF

Requires improvement

safe: Requires improvementwell-led: Requires improvement

Care 4U Services (Midlands) Ltd received a second consecutive 'Requires Improvement' rating following a focused inspection of Safe and Well-Led, with continuing breaches of Regulation 17 (Good Governance) and unresolved concerns around care planning, medication records, infection control, and failure to notify CQC of notifiable incidents. While some improvements had been implemented since the previous inspection, governance and oversight systems remained insufficiently embedded to ensure consistent safe care for the 35 people using the service.

Concerns (11)

criticalCare planning: “Another person was diabetic. There was no risk management plan to tell staff what to do and signs to look out for if the person's blood sugar levels were too high or too low.”
criticalCare planning: “Risk assessments and risk management plans were not always in place to protect people from the risks of recognised health conditions.”
criticalGovernance: “Statutory notifications had not always been sent to us for notifiable incidents. This is a legal responsibility and we could not be confident we had been informed.”
criticalMedication management: “A medicines audit signed as completed on 5 January 2021 and with no errors, had unexplained omissions...Medicines administration records...did not have the dosage required.”
moderateInfection control: “The registered manager did not undertake any health screening questions, take our temperature or ask if we had any COVID-19 related symptoms.”
moderateInfection control: “The provider did not always dispose of used PPE effectively and safely...transported it to their sister care home for disposal in their clinical waste...not in line with government guidelines.”
moderateIncident learning: “The provider's falls and incidents records were not always analysed for any emerging trends or patterns.”
moderateGovernance: “Some completed audits and resulting actions remained in the people's homes and were not kept centrally...registered manager's did not have good oversight of the quality of care.”
moderateRecord keeping: “For some audits, the registered manager explained what was reviewed, but they failed to record what was checked, what was found and what actions had been taken.”
moderateStaff competency: “Some people still felt staff were not always confident or competent in manual handling techniques and supporting people to move safely.”
moderateComplaints handling: “Two people told us they felt uncomfortable about raising concerns, as they were worried about how this would impact on their care.”

Strengths

· Staff were trained in safeguarding and understood their responsibility to report concerns, accidents and incidents to the registered manager.
· Sufficient PPE and hand sanitiser supplies were available in the office, with processes to ensure staff had a regular supply.
· Suitable employment checks were completed to help ensure staff were of appropriate character.
· The registered manager and managing director welcomed inspection feedback and implemented improvements to auditing systems following the visit.
· People received monthly reviews of their care, adapted to telephone calls during COVID-19 to maintain safety.

Inspection report · 2022-12-31

Framework: KLOE · 17 pages · 85 KB · PDF

Inadequate

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

Care 4U Services (Midlands) Ltd was rated Inadequate overall and placed in special measures following an October 2019 inspection that found widespread breaches across safe care and treatment, safeguarding, governance, staffing and recruitment. Critical failures included unsafe medication management, unmonitored missed visits, serious recruitment gaps, an unmitigated safeguarding allegation, and ineffective quality audits that failed to detect any of these concerns.

Concerns (13)

criticalSafeguarding: “there was an allegation of abuse against a member of staff; the registered manager had allowed the member of staff to remain at work without putting in adequate measures to safeguard people.”
criticalMedication management: “Medicine administration records (MAR) contained little or no information about the medicines people should be receiving. For example, one medicine record described the tablet as 'blister pack'.”
criticalMissed or late visits: “System in place to monitor late and missed calls were not robust... not all of these calls were documented. One person said, 'They missed my dinner time call [so I didn't get any dinner].'”
criticalGovernance: “Audits did not identify serious concerns with recruitment and numerous other areas... the lack of robust quality assurance meant people were at risk of receiving poor quality care.”
criticalStaff training: “26 of the 32 staff members had been employed for more than 12 weeks and should have completed all their training but none of them had.”
criticalStaff competency: “references were not from previous employers, and there were gaps in staffs' work history... staff were working with people without the necessary checks.”
moderateCare planning: “Care plans did not contain evidence of a detailed needs assessments and some people told us they had not completed a care plan with the provider.”
moderateSupervision / appraisal: “I've not had a supervision. I didn't have an induction, I haven't had anything. I had a handover from [staff] that's all I got.”
moderatePerson-centred care: “People's wishes, and goals were not considered in their care plans or discussed with people.”
moderateLeadership: “Some staff, people and relatives told us they did not know who the registered manager or deputy manager were.”
moderateRecord keeping: “A staff member told us they had people's risk assessment documents in their car and were due to update them. This meant people's personal information was not stored securely.”
minorEnd-of-life care: “There was no evidence in people's care plans that end of life had been discussed.”
minorCultural competency: “one person was practicing a religion that could require a specialist diet... Their care plan did not tell staff about the person's dietary preferences and if they followed a religious diet.”

Strengths

· Staff understood their responsibilities in relation to mental capacity and gaining consent, and sought people's consent before providing support.
· Staff knew the signs of abuse and correct procedure to report concerns, including external escalation to CQC or social workers.
· Staff had access to PPE (gloves and aprons) to minimise infection risk.
· People had input from community professionals such as GPs, specialist nurses and speech and language therapists.
· Some relatives reported positive experiences, describing individual staff members as excellent and caring.

Quality-Statement breakdown (18)

safe: Staffing and recruitment; Learning lessons when things go wrongInadequate
safe: Assessing risk, safety monitoring and management; Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Preventing and controlling infectionNot rated
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 law; Supporting people to eat and drink enoughRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood

Inspection report · 2022-12-31

Framework: KLOE · 12 pages · 82 KB · PDF

Requires improvement

safe: Requires improvementwell-led: Requires improvement

Care 4U Services (Midlands) Ltd improved from Inadequate to Requires Improvement following a focused inspection of Safe and Well-led, resolving breaches of Regulations 12, 13 and 19, but remaining in breach of Regulation 17 due to insufficient governance systems, inconsistent care plan detail, and gaps in staff knowledge of external safeguarding escalation procedures.

Concerns (9)

criticalGovernance: “Not enough improvement had been made at this inspection and the provider was still in breach of regulation 17”
moderateSafeguarding: “staff did not always understand the local authority safeguarding procedures. This meant they did not have the knowledge or information to escalate matters externally”
moderateCare planning: “some required more detail to ensure staff had enough information to support people with specialised mobility equipment such as banana boards and continence aids”
moderateStaff competency: “When they started I had to show staff how to use the banana board – not trained in using one at all. Never seen one.”
moderateMedication management: “more detail was needed to ensure these were given safely and consistently by staff”
moderateComplaints handling: “not all people spoken with had confidence in the complaints process as some of their concerns about staff practice continued”
moderateRecord keeping: “there was no record of what was included in these audits. We raised this with the registered manager who agreed to implement an improved auditing system.”
minorInfection control: “we received some concerns from people that staff were not always effectively following infection control guidance in their everyday practice”
minorCultural competency: “complaints they made about staff practice continued. This included staff speaking in their own language during personal care”

Strengths

· Provider completed an audit of recruitment records with HR consultancy, implementing robust recruitment practices including DBS checks and references.
· Electronic care planning system implemented providing oversight of call timing, risk assessments and care records accessible via app.
· Staff trained in safeguarding and understood responsibility to report concerns to the registered manager.
· Staff completed the Care Certificate and gave positive feedback about training.
· Provider risk-assessed staff vulnerability to COVID-19 and maintained sufficient PPE and hand sanitiser supplies.

Inspection reports (6)