safe:Requires improvementeffective:Inspected but not ratedcaring:Not ratedresponsive:Inspected but not ratedwell-led:Requires improvement
Day and Nite Services (Kingston) improved from Inadequate to Requires Improvement following a focused inspection, with breaches of safe care, staffing and notifications remediated but a continued breach of Regulation 17 (Good Governance) remaining due to ineffective quality assurance systems failing to identify care planning and medicines record gaps without inspector input. Positive feedback from people, improved supervision, electronic call monitoring and medicines systems were noted as strengths.
Concerns (6)
criticalGovernance: “We requested raw data from the provider from its call monitoring system to analyse care worker visit times which they were unable to provide.”
criticalCare planning: “Another person who was at risk of seizures did not have this risk clearly identified in their care plans.”
moderateRecord keeping: “gaps in records were not always followed up. When we raised this with the managers during the inspection. They acted promptly and immediately followed up with the individual care worker”
moderateCare planning: “a specific health care risk assessment relating to catheter care was not sufficiently detailed. This meant staff might not have access to all the information they required”
moderateLeadership: “the registered manager was available by phone during the inspection, they were not responsible for day to day management of the service.”
moderateIncident learning: “records were not always available to evidence that this had been acted upon...the manager could not provide any evidence that this had been done.”
Strengths
· Electronic call monitoring system introduced to alert managers in real time about late or early care worker visits.
· People and relatives reported feeling safe and receiving consistent care from regular care workers.
· Staff underwent robust pre-employment and DBS checks.
· Electronic medicines system introduced to flag administration and recording errors in real time.
· Staff received up-to-date training including dementia awareness, moving and handling, infection control and MCA.
Quality-Statement breakdown (12)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceInspected but not rated
responsive: Improving care quality in response to complaints or concernsInspected but not rated
well-led: Managers and staff being clear about their roles, 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
Day and Nite Services (Kingston) deteriorated to Inadequate and was placed in special measures, with continued breaches of governance and notifications and new breaches of safe care and treatment and staffing including unreliable call timekeeping, weekend staffing shortages and inaccurate risk assessments. People still found care workers kind and caring, but office management, complaints handling, supervision and quality assurance oversight were significantly poor.
Concerns (13)
criticalMissed or late visits: “They say it (the visit) will be at 11am and it might not be until 2 or 3pm... Weekends, you never know who is coming”
criticalStaffing levels: “a number of care packages were being refused as there were significant staffing issues, especially at weekends”
criticalGovernance: “the governance and quality assurance checks failed to identify the issues we found in relation to staff timekeeping”
criticalSafeguarding: “The provider failed to submit a notification about these in line with their regulatory responsibilities”
criticalCare planning: “One person's care plan said they needed support with their catheter. However, in this person's risk assessment... it stated, 'No catheter in use'”
moderateRecord keeping: “approximately only forty percent of peoples' paper records, including risk assessments and management plans, had been transferred onto the providers electronic care planning system”
moderateMedication management: “The provider was not able to produce any MAR charts when we requested these during the first day of the inspection”
moderateSupervision / appraisal: “staff were still not receiving regular formal supervision, in addition staff did not receive individual supervision”
moderateLeadership: “The registered manager was not a visible presence at the service and there had been periods where she was not in day to day charge of the service”
moderateComplaints handling: “We were not assured that the provider was capturing and recording all the complaints that had been received”
moderateCommunication with families: “we received mixed feedback from people regarding call visit times and of poor communication from the office when care workers were running late”
moderateIncident learning: “where there were follow up actions for the provider to do, it was not always clear if these were followed through”
minorInfection control: “On our arrival at the office staff failed to ask us for evidence to show we did not have COVID-19, contrary to the provider's own infection control/COVID-19 procedures”
Strengths
· People felt safe with care workers and were generally satisfied with quality of individual care
· Care workers were described as kind, caring, polite and considerate
· Privacy, dignity and independence were respected and promoted
· Dietary and nutritional needs were being met with reference to preferences and medical needs
· Recruitment checks for new staff had improved and the provider was no longer in breach of Regulation 19
Quality-Statement breakdown (18)
safe: Staffing and recruitmentNot rated
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: Preventing and controlling infectionNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standardsNot rated
effective: Supporting people to eat and drink enough to maintain a balanced diet