Charnat Support Services improved from Inadequate to Requires Improvement, with the provider no longer in breach of safeguarding regulations but still in continued breach of Regulation 17 (Good governance). Audits failed to identify inconsistencies in care records, MARS charts and training records, though staff demonstrated strong person-centred values and relatives reported high-quality care.
Concerns (6)
criticalGovernance: “The provider's audits to monitor the quality of the service were not consistently effective in identifying issues.”
moderateRecord keeping: “We found inconsistencies in care records and changes to some people's health conditions had not been reflected in care plans.”
moderate
Medication management
: “Audits conducted had not identified the gaps we found in one person MARS charts.”
moderateStaff training: “We also found inconsistences in training records with some staff members training expired and requiring updates or refreshers.”
minorSafeguarding: “We found improvements were required to DBS risk assessments to ensure they were specific to the individual concern and how that could potentially have an impact on people.”
minorStaff competency: “improvements could be made to the recorded information gathered after completing a competency check such as themes, lessons learned, and action taken following a competency check.”
Strengths
· Systems were in place to protect people from the risk of abuse and harm
· People received their medicines as prescribed and on time
· Infection control policies and procedures were in place to keep people safe
· Strong focus on supporting people to be independent, develop their skills and access their local community
· Person-centred care promoting dignity, privacy and human rights
Quality-Statement breakdown (12)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Continuous learning and improving careNot rated
well-led: Working in partnership with othersNot rated