Provision Care Ltd is a domiciliary care agency that provides care to older people, younger adults, people living with dementia, mental health needs, physical disabilities and sensory impairments, within their own homes. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people received personal care. This is help with tasks relation to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were 2 people receiving personal care. This inspection was carried out to follow up on issues identified at the last inspection. At our last inspection there were areas needing improvement. This included medicines management, staff training and the safe recruitment of staff. Governance and oversight of the service also required improvement. At this inspection improvements had been made, and the provider was no longer in breach of regulations. As this was a small service, we could only gather feedback from a limited number of people. To enable our assessment to be as comprehensive as possible we reviewed multiple records the provider held to enable us to make an informed judgement of the quality of care provided. We also spoke with care staff, the registered manager and care coordinator and reviewed feedback from health professionals. We also looked at care plans, recruitment files, audits and quality assurance records. Risks to people's health had been identified and were monitored and managed safely. Staff understood their roles and responsibilities to provide ongoing safe care. Safely recruited staff received ongoing training to ensure they could meet people’s needs safely; this included medicines administration and specific training to support and monitor people’s healthcare. Checks were in place to ensure staff followed the provider’s policies and procedures including best practices in relation to infection prevention and control and people’s mental capacity to consent to care and treatment. The culture in the service was positive. The registered manager was open and transparent and welcomed feedback. There was a strong emphasis on teamwork and good communication across the service. Enough suitably experienced staff were deployed to ensure care was delivered at the time it was arranged for.
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Provision Care Ltd was rated Requires Improvement overall, with breaches identified in regulations 12 (safe care and treatment), 17 (good governance) and 19 (fit and proper persons employed) covering medicines, pre-employment checks, support planning and quality assurance. While caring remained Good with positive relative feedback, the service had deteriorated from its previous Good rating due to weak governance, training oversight and record keeping.
Concerns (15)
criticalMedication management: “Topical medicines (creams) were not managed safely. Creams were applied by staff during personal care, but staff did not record when and where these creams were applied.”
criticalMedication management: “People were at risk of not receiving 'when required' medicines safely as there was no guidance available for staff.”
criticalStaff competency: “The provider was unable to evidence staff had been assessed as competent to administer medicines.”
criticalStaff training: “The provider failed to identify and provide training for staff to support people with specific needs or health conditions. For example; managing diabetes, de-escalation techniques and working with mental health.”
criticalStaff training: “gaps in mandatory training such as medication administration were identified, indicating staff were not adequately trained to meet care needs.”
criticalGovernance: “There was a lack of robust and effective quality assurance processes in place to monitor the quality of the service.”
criticalGovernance: “The training matrix was not fit for purpose... did not detail when the training had been completed and therefore, did not identify when training needed to be renewed.”
criticalOther: “The provider did not carry out pre-employment disclosure and barring service checks in line with organisational policy and procedure.”
moderateCare planning: “Personalised support plans were in place, however, they lacked detail about people's support needs.”
moderateCare planning: “Individualised support plans lacked detail and in some instances were contradictory.”
moderateComplaints handling: “Complaints were not recorded... people had complained about care staff being late and using their phones during support, but there was no record of this.”
moderateRecord keeping: “There was no system or process in place to record or analyse times of care visits. This presented a potential risk of people not receiving their care at the time required.”
moderateEnd-of-life care: “Staff were not trained in end of life care and lacked knowledge in this area... there was a risk their needs would not be met appropriately if their needs changed.”
moderateCommunication with families: “The provider had not considered how to ensure the Accessible Information Standard was adhered to. There were no alternative versions of documents to ensure people with specific needs had access to information.”
moderateIncident learning: “During the inspection, we identified one incident that had not been reported as required.”
Strengths
· Positive feedback from relatives: 'We'd like to say a big thank you, can't praise them enough'.
· Staff received safeguarding training and understood how to report concerns.
· Staff received infection control training and PPE was available; provider demonstrated learning during the pandemic.
· Staff protected people's privacy and dignity and promoted independence.
· People were supported to make their own food and drink choices.
Quality-Statement breakdown (24)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
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 experience
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Requires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
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
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood