VIP Homecare received an overall rating of Requires Improvement at this focused follow-up inspection, remaining in breach of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) due to incomplete risk assessments and insufficiently robust auditing systems. Safeguarding improvements were noted and the service demonstrated strengths in staffing, medicines management, infection control, and a positive person-centred culture.
Concerns (5)
criticalCare planning: “risk assessments were still not in place for all identified risks. There was no specific information on how to monitor the risks associated with catheter care.”
criticalGovernance: “auditing systems in place were not robust enough to ensure all records contained the updated documents.”
critical
Care planning
: “no risk assessment in place for the use of this moving and handling equipment... no catheter care risk assessments, allergies risk assessments or moving and handling equipment risk assessments.”
moderateRecord keeping: “audit was in place for the reviewing of people's daily records, however there was no document to demonstrate the completion of the audit.”
moderatePerson-centred care: “registered manager had put in place a diabetes care plan for 1 person; however, it did not contain enough information to inform staff of how to meet their specific needs.”
Strengths
· Safeguarding improvements made; provider no longer in breach of Regulation 13
· People supported by enough consistently deployed, safely recruited staff
· Medicines safely managed with administration records, care plan information, and competency checks
· Effective infection prevention systems in place with continuous PPE supply
· Positive, person-centred culture with staff showing passionate approach to care
Quality-Statement breakdown (11)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
well-led: Managers and staff being clear about their roles, 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
VIP Homecare was rated Requires Improvement overall, with breaches of Regulations 12, 13 and 17 relating to risk assessment, safeguarding and governance, including a failure to notify CQC of a serious pressure sore. Caring practices remained Good, but care planning, staff training, mental capacity assessments and quality assurance systems all required significant improvement.
Concerns (9)
criticalSafeguarding: “Some staff we spoke with lacked understanding of their safeguarding responsibilities. For example, one member of staff was unaware of how to report or record safeguarding concerns.”
criticalCare planning: “Care plans did not always provide clear guidance for staff to follow on how to meet people's individual healthcare needs.”
criticalStaff training: “not all staff had completed first aid training, moving and handling training or pressure ulcer prevention training.”
criticalGovernance: “The provider's quality assurance systems and processes were not effective. Although a programme of audits was in place, this had not enabled the provider to identify and address the shortfalls”
criticalIncident learning: “one person had developed a serious pressure sore when receiving care from the service. The provider had failed to notify us of this injury.”
moderateConsent / capacity: “When a person's capacity to consent to particular elements of their care was in doubt, the provider told us they had not always ensured a mental capacity assessment was completed.”
moderateRecord keeping: “care plans and risk assessments were not consistently updated as needed to reflect advice from external professionals.”
moderateEnd-of-life care: “People's assessments and care plans did not always include information regarding people's end of life wishes. The provider told us they would not normally ask about people's end of life preferences.”
moderateStaff competency: “I feel [staff] should have more training and shadowing.”
Strengths
· Positive feedback on caring manner of staff; people treated with dignity and respect
· Safe recruitment practices including DBS and reference checks
· Medicines administered safely and as prescribed, with competency assessments
· Good punctuality and reliability of calls reported by people and relatives
· Effective complaints handling system with concerns resolved appropriately
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongGood
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: Ensuring consent to care and treatment in line with law and guidance
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Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting access to healthcareRequires improvement
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 meet needs and preferencesRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships and follow interestsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about roles; understanding quality, risks and regulatory requirements; continuous learningRequires improvement
well-led: Promoting a positive, person-centred, open culture; duty of candourGood
well-led: Engaging and involving people, public and staff; working in partnershipGood