NDH Care Ltd was rated Requires Improvement overall following a focused inspection of safe and well-led domains, with regulatory breaches found in risk and medicines management (Regulation 12) and governance (Regulation 17). Key failings included incomplete medication records, absent staff guidance on risk mitigation, unidentified safeguarding concerns, and ineffective quality assurance audits, leading to CQC imposing additional conditions on the provider's registration.
Concerns (7)
criticalMedication management: “MAR did not record the name of medicines to be given, the dosage needed or route of administration. People's allergies had also not been recorded on MARs.”
criticalCare planning: “Although the provider had identified risks in relation to pressure areas and continence care, there lacked any guidance for staff on how to support people with their risks.”
criticalSafeguarding: “The provider had not identified possible concerns around neglect... deterioration had not been identified by the provider and so no action could be taken to safeguard the person.”
criticalGovernance: “The provider's quality assurance systems were ineffective in identifying areas for improvement... audits were completed, these were not used as a tool to continuously learn and improve care.”
criticalRecord keeping: “Medicine records failed to include all of the necessary information to ensure staff supported people with medicines in a safe way.”
moderateIncident learning: “The information lacked relevant detail and did not evidence that the provider reviewed incidents to identify any trends or patterns to reduce the risk in future.”
moderatePerson-centred care: “They don't have a problem with apologising but they don't seem to learn from their mistakes... this was not acted upon.”
Strengths
· Staff understood their responsibilities to report concerns of abuse and safeguarding.
· Staff had been recruited safely, including DBS checks and references from previous employers.
· People received support from a consistent team of staff who mostly arrived on time.
· Staff reported having sufficient time to provide care safely and felt supported by management.
· Infection control practices were improved following concerns, including PPE use, COVID-19 testing systems, and office hygiene measures.
Quality-Statement breakdown (9)
safe: Preventing and controlling infectionGood
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood