We carried out an assessment of Adonai Healthcare Services between 18 November and 21 November 2024. This was to follow up on the shortfalls we found at our last visit. We looked at all the quality statements within all five key questions. The service is a domiciliary care agency providing personal care to people living in their own homes. At our last visit we identified eight breaches of regulation. These were in person-centred care, treating people with respect and dignity, obtaining consent, risks to people, complaints processes, good governance, staffing arrangements and recruitment processes. We issued requirement notices for the breaches of regulation and placed the service in special measures. Improvements were found at this inspection as the registered manager had worked closely with a consultant to address the shortfalls. As such, we found breaches of regulation had been met in relation to person-centred care, treating people with respect and dignity, obtaining consent, complaints processes, staffing and recruitment processes. The overall rating for the service is no longer inadequate and therefore, the service is no longer in special measures. However, despite the widespread improvements, we identified continued concerns relating to risks to people and good governance as further work was needed to ensure robust systems and processes were in place. Risk assessments were included in people’s care plans but some did not contain sufficient information to help ensure staff knew how to keep people safe. Auditing arrangements were more robust, but despite this audits had not identified gaps in care plans or that information was not contemporaneous. Staff felt supported by the registered manager and they received appropriate training, supervision as well as the opportunity to express their views on how the service was run.
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Adonai Healthcare Services received an Inadequate overall rating at its first inspection, with breaches across nine regulations including safe care and treatment, medicines management, staffing, consent, person-centred care, dignity, complaints, recruitment and governance. The service was placed into special measures due to widespread failures in risk assessment, medication records, staff training, call reliability and quality oversight, with warning notices served for four regulations.
Concerns (16)
criticalCare planning: “Care plans did not always detail risk to people's individual needs and guidance on how staff should support them.”
criticalMedication management: “On the first day of our inspection, the manager told us that there were no medication administration records (MARs) in place and in use.”
criticalStaffing levels: “10% are more than 45 minutes late. This meant some people had not received their care as scheduled or planned.”
criticalMissed or late visits: “A relative phoned at 10:26am to inform the manager that their carer had not turned up to their 09:30am call.”
criticalStaff training: “Staff had not been trained in diabetes, catheter care, Parkinson's disease and epilepsy despite providing care and support to people with these conditions.”
criticalStaff competency: “Staff received moving and handling training through an online course, this meant that they did not practice using equipment as part of their training.”
criticalConsent / capacity: “The provider failed to follow the principles of the Mental Capacity Act 2005. Capacity assessments had not always been completed.”
criticalIncident learning: “The manager told us there was no accident and incident records... There had been no learning from accidents and incidents.”
criticalGovernance: “Audits and checks had not been taking place by the provider or the manager... The provider could not demonstrate continuous learning and improvement.”
criticalSafeguarding: “Safeguarding concerns had been reported to the local authority in relation to allegations of neglect. However, the provider had not recognised that CQC needed to be informed.”
criticalPerson-centred care: “People had not been involved in developing their care plans. There was little personal information about people in their care records.”
criticalComplaints handling: “The agency had received 9 complaints since it started... We found no records/logs of complaints received and how these were responded to.”
criticalRecord keeping: “Records were inconsistent and did not include a complete, accurate and contemporaneous record of care needs.”
criticalLeadership: “The service was required to have a registered manager in post. The previous registered manager had left in January 2023. No applications to register a new manager had been received by CQC.”
moderateSupervision / appraisal: “Staff did not meet with the management team to discuss their personal development or support they needed. There were no records of supervisions carried out.”
moderateEnd-of-life care: “At the time of our inspection 1 person was at end of life. Care plans did not contain information in relation to the care and support people wished to receive at end of life.”
Strengths
· Staff followed safe infection prevention and control practices including wearing appropriate PPE.
· People and relatives consistently described individual staff as kind, caring and friendly.
· The manager was visible, accessible and known to people and relatives.
· DBS criminal record checks and reference checks were completed for staff.
· People's communication needs were identified in care plans in line with the Accessible Information Standard.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsInadequate
well-led: Continuous learning and improving careInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Working in partnership with othersRequires improvement