Focused inspection of a domiciliary care agency found a continued breach of Regulation 12 due to ongoing medicines management failings including missing risk assessments, MAR discrepancies and weak audit follow-up. The effective domain improved to Good, but safe and well-led remained requires improvement amid governance gaps and absence of a registered manager.
Concerns (7)
criticalMedication management: “we did not see any medicines risk assessments or information on where medicines were stored in people's homes.”
criticalMedication management
: “Medicines care plans did not always match the medicines support being provided... staff signed to say they had administered the medicines. This was not in accordance with the national guidance.”
moderateRecord keeping: “there was no system to check them for accuracy before using them. We found mistakes and discrepancies on MAR charts that the staff had not identified.”
moderateIncident learning: “When medicines issues were identified, staff did not always take action to avoid reoccurrence.”
moderateCare planning: “Further work was required around risk assessing specific health care conditions, such as diabetes, and formulating guidance to ensure staff were aware of these conditions”
moderateGovernance: “Staff changes and sickness led to delays in the auditing process and, at times, the thoroughness of checks. This, for example, affected the quality of the medicines' audits”
minorLeadership: “the service did not have a registered manager, which is a legal requirement.”
Strengths
· Safe recruitment procedures including references, ID checks and DBS checks
· Effective infection prevention and control with PPE and regular COVID-19 testing of staff
· Robust, detailed, person-centred care plans reflecting cultural and religious needs
· Staff received induction, mandatory training and quarterly supervisions/spot checks
· Strong support initiatives for staff including counselling and clinical supervision
Quality-Statement breakdown (16)
safe: Using medicines safelyRequires improvement
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: 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
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
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Duty of candourGood
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: Continuous learning and improving care, Working in partnership with othersGood