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

Inspection report · 2023-02-22

Framework: KLOE · 22 pages · 108 KB · PDF

Requires improvement

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

St Gregory's Homecare Ltd remains in special measures with an overall rating of Requires Improvement following inspections in November–December 2022, with breaches of Regulations 9, 12, 13, 17 and 18 and a warning notice issued for governance failures. While some improvements were made since the previous Inadequate rating, significant risks persist around safeguarding, medicines management, staff competency, person-centred care, and an ineffective quality assurance system.

Concerns (10)

criticalSafeguarding: “People were not always protected against the risk of abuse. On occasions, people were subjected to neglect by care staff, causing people distress and discomfort.”
criticalGovernance: “The provider's quality assurance system had not identified issues we found on inspection, including with safeguarding, risks to people, medicines, staff competencies, care records.”
criticalMedication management: “Best practice guidance was not always followed. This included guidance to support the safe use of topical medicines, such as creams, gels and patches.”
criticalStaff competency: “Care workers carried out specialist care tasks for which they had not always had their competence assessed to ensure they were safe.”
criticalIncident learning: “Lessons were not always being learnt to prevent further safeguarding allegations. The provider sent a care worker to a person following previous allegations about the same care worker.”
moderateCare planning: “Care plans and risk assessments did not always contain information on risks linked to people's health needs, such as catheter care.”
moderatePerson-centred care: “People's preferences for female care workers were not always considered or recorded in their care records.”
moderateMissed or late visits: “For only 2 out of 28 visits care staff stayed for the full length of the care visit that the person was commissioned to receive.”
moderateEnd-of-life care: “End of life care plans were not always in place for people receiving end of life support. We were not assured staff would have sufficient information to guide them.”
moderateRecord keeping: “Full information about risks to people's safety was not always identified in people's care records to alert staff and guide them in how to reduce the risk.”

Strengths

· Provider raised safeguarding concerns with the relevant local authority in an open and transparent way.
· People were supported by care staff who had been safely recruited.
· Improvements made to coordination of care visits requiring more than one care worker.
· Provider no longer in breach of Regulation 14 (nutritional and hydration needs).
· Provider no longer in breach of Regulation 11 (consent/MCA).

Quality-Statement breakdown (20)

safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidance

Inspection report · 2022-04-22

Framework: KLOE · 22 pages · 108 KB · PDF

Inadequate

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

St Gregory's Homecare Ltd was rated Inadequate overall and placed in special measures, with widespread breaches across safeguarding, safe care, consent, nutrition, person-centred care, complaints, staffing and governance. People experienced late and missed visits, rushed task-centred care, inconsistent infection control and unsafe medicines management, while leaders failed to monitor quality or act on feedback.

Concerns (19)

criticalMissed or late visits: “People often received care visits either early, late or in some instances the care visit was missed.”
criticalSafeguarding: “safeguarding concerns were not being raised by the provider in-line with local arrangements.”
criticalGovernance: “There were significant and widespread shortfalls in the governance of the service, placing people at risk of harm.”
criticalLeadership: “Roles, responsibilities and accountability were not clear within the provider's management and staffing structure.”
criticalMedication management: “Information on people's GP medicines lists did not always match with the provider's electronic medication administration records”
criticalCare planning: “Care plans and daily care records contained standardised information with limited evidence of person-centred care.”
criticalStaff training: “It was not clear if staff had received training in areas such as safeguarding, end of life care, first aid or mental capacity.”
criticalStaff competency: “Competence checks were not carried out to assess staff knowledge and skills in areas such as moving and handling and medicines.”
criticalStaffing levels: “the provider had failed to ensure there were sufficient staff to meet people's needs.”
criticalSupervision / appraisal: “The provider had not followed their supervision policy and 62% staff had not received supervision in the last 12 months.”
criticalIncident learning: “It was not clear lessons were learnt following safeguarding concerns to prevent reoccurrences and keep people safe.”
criticalPerson-centred care: “Care was organised by the provider in a way that was task-centred and was not always person-centred.”
criticalComplaints handling: “the provider had failed to investigate and take action in response to a complaint and have effective systems for handling and responding to complaints.”
criticalInfection control: “People were not always protected from the risk of infection due to inconsistent infection prevention and control practice by care staff.”
criticalConsent / capacity: “It was not clear whether people's capacity to consent to their care arrangements was assessed by the provider.”
criticalEnd-of-life care: “The provider was not well prepared for caring for people needing end of life care.”
moderateCommunication with families: “People, relatives and staff all reported instances where they had not been able to make contact with the office.”
moderateRecord keeping: “The provider did not always keep records where people had lasting power of attorney in place”
moderateCultural competency: “People's diverse needs were not always considered or well recorded.”

Strengths

· Care staff were recruited safely with appropriate checks carried out
· The provider had implemented innovative solutions to support recruitment and retention of care staff
· More recent care visit times reviewed showed some improvements in timeliness
· Commissioner feedback suggested provider had made improvements to work within service capacity
· Provider made changes to phone system following inspection to improve communication

Quality-Statement breakdown (18)

safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongNot 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
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff support: induction, training, skills and experience

Inspection reports (8)