Kent and Medway Domiciliary Care Agency was rated Inadequate overall following a January 2023 inspection, with breaches identified across safeguarding, safe care and treatment, dignity and respect, person-centred care, staffing, and governance. Inspectors found unlawful restraint, significant medication management failures, a closed and disrespectful staff culture, and ineffective governance systems, placing the service into special measures.
Concerns (14)
criticalSafeguarding: “Staff had used unlawful restraint on a person, and this had not been reported. A Staff member told us that a person was forced to sit on the toilet after they communicated with staff that they didn't want to.”
criticalMedication management: “One person's MAR was blank for the last entry and we observed there to be none of this medication in stock. During our medicine count we found one person had 8 tablets missing with no explanation.”
criticalStaff training: “Staff told us they had not completed face to face MAPPA training. One staff member told us they had not received epilepsy training and they didn't know if the person had any medicines for this.”
criticalGovernance: “Robust governance systems and processes were not in place to identify issues. Quality assurance audits had not highlighted the errors we found during inspection, including 'as required' medicines not being available.”
criticalIncident learning: “Incidents of unlawful restraint were not recorded. The registered manager could not be assured that learning from these incidents could be implemented to reduce the likelihood of reoccurrence.”
criticalLeadership: “The registered manager had also failed to pick up on the abuse that people had been subjected to within the service. Staff told us they did not always feel supported by management.”
criticalStaff competency: “The skills of staff did not always match the needs of the people using the service. One staff member was just shown what to do by another staff member regarding MAPPA.”
criticalConsent / capacity: “The service was not always working within the principles of the MCA. People were subjected to unlawful restraint and a person was forced to sit on the toilet after they communicated they didn't want to.”
moderateCare planning: “One person's care and support plan had not been reviewed since August 2021. People's PBS plans did not consistently reflect people's most up to date needs.”
moderatePerson-centred care: “One person told us they would like to set some goals but were unsure where to start and had not been supported by staff to do so. One person had not been weighed since being supported by this provider.”
moderateRecord keeping: “Daily records did not corroborate what staff had told us or reflect people's current needs. Daily notes for some people included '[person] woke up with an attitude', '[person] put on the seizure'.”
moderateSupervision / appraisal: “The registered manager carried out competency assessments for staff however these were not always effective when highlighting the lack of support staff felt.”
moderateInfection control: “One room we observed there to be no toilet seat on the persons toilet. Other rooms we visited were visibly unclean and odorous.”
minorComplaints handling: “One relative told us of a complaint they had made but were unaware of the outcome. The service had investigated the complaint but had failed to fully convey and involve the relatives with the outcome.”
Strengths
· The service had enough staff to support people in line with their care and support plans, with an effective system to ensure shifts were allocated and covered.
· Pre-employment checks were completed in line with policies, including up to date DBS, employment history and references.
· People had health passports in place to support other health professionals, and staff ensured people could access emergency healthcare when needed.
· People were supported to maintain relationships with family and friends, and relatives reported they were always able to see their loved one.
· Staff supported people with complex dietary needs, including modified diets, and some people were supported to do food shopping on a weekly basis.
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentGood
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: Supporting people to live healthier lives, access healthcare services and supportRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
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
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
Kent and Medway Domiciliary Care Agency improved from Inadequate to Requires Improvement overall, exiting Special Measures, with Good ratings in Effective, Caring and Responsive domains. Remaining concerns centre on a safeguarding incident not reported to the local authority or CQC, a medication dosing oversight for a low-weight person, incomplete record-keeping, and the absence of a registered manager.
Concerns (6)
criticalSafeguarding: “There had been a serious incident of verbal abuse between 2 people...This had not been appropriately reported...The local authority and CQC had not been informed.”
moderateMedication management: “They weighed below 50kg and the provider had not followed NHS choices guidance 'How and when to take paracetamol for adults'...The person's dose had not been checked.”
moderateCare planning: “Staff had written 'personal care given' but they had not detailed what they had supported with...A person's mental capacity assessment was missing the best interest section.”
moderateGovernance: “The service was required to have a registered manager in post. The previous registered manager had deregistered in June 2023. No applications to register a new manager had been received.”
moderateIncident learning: “The provider and management team understood their role...had notified CQC about events that had occurred apart from one allegation of abuse which was reported retrospectively.”
minorRecord keeping: “Person centred fire risk assessments...contained generic guidance...Personal emergency evacuation plans (PEEPs) did not provide all the information staff needed to understand how to safely evacuate people.”
Strengths
· Staff supported people to have maximum possible choice, control and independence, focusing on strengths and promoting what people could do.
· People were well matched with designated support workers, resulting in ease, happiness and engagement.
· Staff received relevant training in evidence-based practice including positive behaviour support, communication tools and human rights.
· Comprehensive, person-centred care and support plans reflected people's range of needs, goals and aspirations.
· Improvements had been made since the previous inadequate rating; the service exited Special Measures.
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
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effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Working in partnership with othersGood
well-led: How the provider understands and acts on the duty of candourGood