ReadyCQC, a weekly field guide to CQC home-care regulation

criticalMedication management: “Medications were not always recorded on a Medication Administration Record (MAR). Some MARs we viewed had missing signatures which would indicate medication had not been administered as prescribed.”
criticalSafeguarding: “An incident we were made aware of during the inspection had not been referred to the relevant safeguarding authority, which meant there had not been an investigation carried out to protect the person.”
criticalCare planning: “Care plan documentation contained information which was either inaccurate or insufficient to enable staff to support people effectively. For example, one person's care record stated they required support with catheter care. The person did not have a catheter.”
criticalConsent / capacity: “The provider did not have up to date mental capacity assessments in place where people lacked the capacity to make all of their own decisions.”
criticalGovernance: “The care notes and MAR audits we reviewed were not completed on a regular basis. Only one of these eight records had been completed since our last inspection in the month of July in 2021.”
criticalStaff training: “We could not be assured staff had received mandatory training such as moving and handling as records did not reflect this. Evidence of these training certificates were out of date.”
criticalIncident learning: “The provider had not implemented sufficient systems and processes to learn lessons when things went wrong. The last inspection rated the service inadequate and we found little or no improvements had been made.”
criticalLeadership: “The provider lacked effective oversight of the service and the systems and processes in place. The provider was unable to readily access documentation held electronically.”
moderateStaff competency: “Some staff had received competency checks, but the provider could not evidence all staff had received checks to ensure staff were skilled and proficient in their role.”
moderateSupervision / appraisal: “The provider was unable to provide evidence to show staff received regular supervisions to monitor staff performance and development.”
moderateRecord keeping: “The provider had no effective way of ensuring staff had received training and supervision. Training and development records were not held centrally.”
moderateMissed or late visits: “Staff are sometimes very late for calls, but staff will phone and tell us they will get to us as soon as they can.”

Inspection report · 2022-10-28

Framework: KLOE · 14 pages · 90 KB · PDF

Requires improvement

safe: Requires improvementeffective: Requires improvementcaring: Goodresponsive: Goodwell-led: Requires improvement

Falcon Carers, a domiciliary care agency supporting 37 people, was rated Requires Improvement overall after demonstrating significant progress and exiting Special Measures, with previous breaches of regulations 11, 12, 13, 17 and 18 now resolved. Caring and responsive were rated Good, while safe, effective and well-led need consistent good practice over time, with minor inconsistencies remaining in electronic care plan records and complaints logging.

Concerns (5)

moderateCare planning: “some of the information had not been recorded consistently in all areas of the electronic system which meant staff may not have always been up to date with people's needs”
moderateRecord keeping: “Care plans had been transferred to the electronic care planning system... However, some of the information had not been recorded consistently in all areas of the electronic system”
moderateGovernance: “the service management and leadership needed to remain consistent over time. Leaders and the culture they created had begun to support the delivery of high-quality, person-centred care.”
minorMedication management: “We could not improve the rating for safe to good because to do so requires consistent good practice over time.”
minorComplaints handling: “The provider was producing a new log for complaints which would include response dates to bring it in line with the policy.”

Strengths

· Significant improvements made since last inspection; no longer in Special Measures and no longer in breach of regulations
· Risk assessments now detailed and comprehensive; staff knew people's needs well
· Improved safeguarding insight, training and reporting practices
· Medicine management much improved with electronic system fully utilised
· Consistent staffing levels with regular supervisions and safe recruitment including DBS checks

Quality-Statement breakdown (22)

safe: Using medicines safelyNot rated
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongNot 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
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law

Inspection report · 2022-08-26

Framework: KLOE · 20 pages · 102 KB · PDF

Inadequate

safe: Inadequateeffective: Inadequatecaring: Inadequateresponsive: Inadequatewell-led: Inadequate

Falcon Carers was rated Inadequate across all five key questions and placed in special measures, with breaches of regulations covering safe care, dignity, safeguarding, complaints, governance, recruitment, staffing and CQC notifications. Inspectors found unsafe medicines management, untrained and uninducted staff, language barriers undermining communication and dignity, ineffective complaints handling, and a provider with little oversight of the service.

Concerns (17)

criticalMedication management: “Medicines were not managed and administered safely which placed people at significant risk of harm.”
criticalRecord keeping: “MARs were handwritten and incomplete. They did not contain all the information required to administer medicines safely including the medicines full name, dosage and frequencies.”
criticalSafeguarding: “We found there were 10 allegations of abuse that had been recorded in a safeguarding folder at the service. The service had not notified CQC.”
criticalStaff training: “The only training I have done with Falcon was medication, I didn't have any moving and handling training with them. I did support people who needed hoisting.”
criticalStaff competency: “Staff were not competent and skilled enough to provide safe and effective care to people.”
criticalGovernance: “The provider failed to operate an effective governance system to assess, monitor and improve the quality and safety of services provided.”
criticalLeadership: “The provider, who was also the manager, had little oversight of the service. They did not have prompt access to all records and documentation required.”
criticalComplaints handling: “There was no effective or accessible system for managing complaints. Complaints were not always appropriately recorded and investigated.”
criticalPerson-centred care: “The care that people received did not always meet their needs or reflect their preferences.”
criticalCare planning: “Care plans were not audited or reviewed... Some care plans were out of date and had not been reviewed but the provider had not identified this.”
criticalIncident learning: “We found there were no accident or incident forms completed regarding these injuries and no action had been taken to reduce the risks to the person or reduce the risk of reoccurrence.”
criticalOther: “Recruitment procedures were not established and operated effectively to ensure that staff were suitable to work with people who used the service.”
moderateSupervision / appraisal: “Staff did not receive regular supervision. The provider told us that most supervisions took place informally and were not documented.”
moderateCommunication with families: “I find communication at this (management) level not the best... Then the next part of the email was a copy and paste job from a generic COVID-19 email.”
moderateCultural competency: “If [staff] knew what you were talking about, they might respect your culture. I'm Irish catholic and was married to a Punjabi but they don't have a clue.”
moderateMissed or late visits: “The evening call should be 9pm but it can be 8:30pm or 9:45pm, it's impossible to settle when you don't know, it doesn't aid recovery.”
moderateConsent / capacity: “We found some examples of relatives giving consent on behalf of a person, without the legal authority to do so.”

Strengths

· People and relatives told us that staff wore suitable Personal Protective Equipment (PPE).
· Staff told us they had PPE available and that they knew how to use it safely; the director regularly delivered PPE to staff.
· Some relatives reported staff worked alongside professionals to ensure people got the healthcare they needed, e.g. alerting families when a district nurse was needed.
· The provider took action to mitigate some of the most serious risks found, including those in relation to medicines practices and staff training.

Quality-Statement breakdown (21)

safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experienceInadequate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Supporting people to eat and drink enough to maintain a balanced diet

Inspection reports (5)