Bexley (Liznett Care Services Ltd) was rated Requires Improvement for the third consecutive inspection, with continued breaches of Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) due to medicines management gaps, incomplete condition-specific risk assessments and weak quality assurance. While safeguarding, recruitment, infection control and staff training were satisfactory, care plans, consent records, accident reporting and timeliness of visits all required further improvement.
Concerns (9)
criticalMedication management: “we looked through ten people's MAR charts and audits for the last 12 months and found unexplained gaps in three people's MAR charts that had not been picked up in the MAR audits”
criticalCare planning: “At the time of the inspection we did not find risk assessments or risk management plans that were specific to people's health conditions.”
criticalGovernance: “Quality assurance systems and processes were not sufficiently robust.”
moderateRecord keeping: “information was not readily available, and records were not always presented promptly during our inspection”
moderateIncident learning: “accident and incident reporting was inconsistent. Reports did not always contain follow up actions nor were they signed off by a manager.”
moderateMissed or late visits: “People told us staff seemed rushed and did not always arrive on time. One person said, 'I think the carers seem rushed at times.'”
moderateConsent / capacity: “care plans contained no information about people's mental capacity other than stating whether they had a diagnosis of a health condition where capacity might fluctuate”
moderateCommunication with families: “people's service user agreements and their care plan reviews were often unsigned or if they were signed the service did not maintain a copy at their registered address”
minorPerson-centred care: “There were mixed views on the service's promotion of independence.”
Strengths
· Safeguarding systems and processes in place with staff trained and aware of how to respond
· Recruitment checks carried out with people's safety in mind
· Staff trained in infection control and provided with PPE
· Staff supported through induction, face-to-face training, supervision, appraisal and spot checks
· Complaints handled professionally and used to drive improvement
Quality-Statement breakdown (23)
safe: Using medicines safely; Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires 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 dietRequires improvement
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: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
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: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
Bexley (Liznett Care Services Ltd) improved from Requires Improvement to Good across all five key questions, with previous breaches of regulations 12 and 17 now resolved. Inspectors found safe, effective, caring, responsive and well-led care supported by robust recruitment, medicines management, governance and a positive staff culture.
Strengths
· Robust safeguarding procedures and staff understanding
· Effective medicines management with EMAR system and fortnightly audits
· Robust recruitment checks including DBS
· Sufficient staffing levels with electronic call monitoring (ECM) to track late or missed calls
· Strong infection prevention and control practices including PPE and COVID-19 training
Quality-Statement breakdown (22)
safe: Using medicines safelyNot rated
safe: Assessing risk, safety monitoring and managementNot 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
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experience