MK Hospital@Home was rated Requires Improvement overall following an October 2023 inspection, with breaches of Regulations 12, 17 and 19 identified in relation to unsafe medicines management, inadequate risk assessment and recording, and insufficiently robust recruitment checks. People and relatives spoke positively about caring and responsive staff, and the provider took immediate remedial action during the inspection, but governance and oversight systems were not effective enough to have detected these concerns prior to inspection.
Concerns (6)
criticalMedication management: “Records used for the administration of medicines did not always identify the actual medication, dosage or time of the administration.”
criticalRecord keeping: “Risk assessments were not always in place for managing some people's needs and those that were, were not always accurate or current.”
criticalIncident learning: “Accident and incidents had not always been documented appropriately; therefore, we could not see what or if actions had been taken to protect people.”
criticalStaffing levels: “Required checks of suitability for staff being employed to work with vulnerable people were not always completed.”
criticalGovernance: “These were not effective or robust enough in highlighting the concerns we found with recruitment, records for managing medicines and risk management.”
moderateCare planning: “Some records we viewed showed changes in people's needs were not always recognised or recorded in a timely way.”
Strengths
· People and relatives consistently praised staff as kind, caring, respectful and patient.
· Staff received training in line with the care certificate, including safeguarding, manual handling and infection control.
· People were involved in developing their care plans and reviews.
· Effective referrals made to external healthcare professionals when needed.
· Complaints handled promptly and management was accessible to people and staff.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
Mk Hospital@Home received a Good rating across all five key questions at its first CQC inspection in January 2023, with 20 people receiving personal care at the time. The service demonstrated strong person-centred values, safe staffing and recruitment practices, and an open, well-managed culture committed to continuous improvement.
Strengths
· People felt safe and protected from abuse; staff trained in safeguarding and confident in reporting concerns.
· Thorough pre-service needs assessments conducted with involvement of people and those who knew them well.
· Staff described as kind, caring, respectful and friendly; people expressed high satisfaction with their carers.
· Person-centred care with flexibility to accommodate individual preferences and changing needs.
· Registered manager carried out working supervisions, observing staff delivering care to assess performance.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles; duty of candourGood
well-led: Engaging and involving people using the service; continuous learning and improving careGood