Home Support Services (Havering & Essex) was rated Good overall at its first inspection since a 2014 legal entity change, with staff delivering kind, person-centred care underpinned by safe medicine management and robust care planning. Two regulatory breaches were identified under Well-Led: failure to notify CQC of safeguarding incidents and ineffective governance systems failing to detect gaps in staff appraisals, DBS renewals, and visit time adherence.
Concerns (5)
criticalGovernance: “Systems or processes although established were not always operated effectively to ensure that appraisals and DBS rechecking were monitored and kept up to date.”
criticalIncident learning: “We found that there had been safeguarding issues within the service in February 2016 and that the registered managers had not sent notifications of these incidents to CQC as required.”
moderateSupervision / appraisal: “We noted that in 2015 some appraisals had been missed. We spoke to the provider about this and they said they would rectify this as soon as possible.”
moderateMissed or late visits: “Staff did not always stay for the full length of the allocated visit time... 'I have a 45 minute call but usually if they finish after 30 minutes they tell me they have to go to the next visit.'”
moderateSafeguarding: “DBS clearances were not always refreshed in accordance with the service's policy. We found two staff with DBS clearances from 2011 and one staff with a DBS clearance from 2012.”
Strengths
· People felt safe and staff were described as caring, kind and treating people with dignity and respect.
· Medicines were managed safely by trained and competency-assessed staff with no discrepancies found in administration records.
· Comprehensive care plans included people's wishes, hopes, aspirations, likes, dislikes and individual preferences.
· Staff received a thorough induction, regular supervision, spot checks and annual training in core areas including safeguarding and manual handling.
· End of life care was supported with staff trained in the Gold Standard Framework, working closely with district and Macmillan nurses.
Home Support Services (Havering & Essex) Limited was rated Good overall at this announced inspection on 26 April 2018, with all five key questions rated Good. Recommendations were made regarding medication administration record-keeping and ensuring care plans fully reflected people's personal routines and preferences.
Concerns (2)
moderateMedication management: “five out of 10 medicine administration records (MARS) had not been completed properly. Either the name of the topical medicine administered was missing or there was just a signature”
minorCare planning: “in five out of 10 care plans that we reviewed some sections were not always updated to detail people's personal routines such as bed time and hot drink preferences”
Strengths
· People told us they felt safe and trusted staff who supported them
· Robust recruitment checks including three yearly DBS refresher checks
· Staff supported by regular spot checks, supervisions and annual appraisals
· Care records reflected people's culture and religious preferences
· Effective complaints process understood by people and staff