Caronne Care Ltd received an overall rating of Requires Improvement at its July 2016 inspection, with three regulatory breaches identified relating to late staff visits posing neglect risks, failed CQC safeguarding notifications, and inconsistent governance and auditing processes. The service demonstrated strengths in safe medicines management, staff training, personalised care planning, and a caring culture, with Good ratings awarded for effective, caring, and responsive domains.
Concerns (5)
criticalMissed or late visits: “My carers are never on time and [registered manager] sometimes calls to say they are going to be late... it affects my care when they are late, I have to wait for a wash.”
criticalGovernance: “Audit tools were available for checking medicines each month but these had not been completed for the last three months.”
criticalSafeguarding: “Notifications concerning safeguarding had not been sent to the CQC, the registered manager had notified the local authority. However they had not informed the CQC as required.”
moderateRecord keeping: “Audit forms relating to the care plan had not been audited and the registered manager advised that any issues were discussed directly with staff in supervision.”
minorSupervision / appraisal: “Some staff we spoke to said that their supervisions were not in private. This meant that conversations staff had with the registered manager were not always confidential.”
Strengths
· People felt safe with their carers and relatives reported peace of mind
· Medicines were handled safely with regular staff training and competency assessments
· Recruitment carried out safely with pre-employment checks completed before unsupervised work
· Staff demonstrated good understanding of Mental Capacity Act 2005 and supported people to make their own decisions
· Care was personalised with detailed needs assessments and regular care plan reviews
Quality-Statement breakdown (14)
safe: Late staff arrivals putting people at risk of unsafe care and neglectRequires improvement
safe: Risk assessments carried out and reviewed regularlyGood
safe: Safe recruitment with DBS checks before unsupervised workGood
safe: Medicines administered safely with training and competency checksGood
effective: Staff training up to date including care certificateGood
effective: MCA principles understood and applied by staffGood
effective: Supervision not always conducted in privateRequires improvement
caring: People treated with kindness, dignity and respectGood
caring: Care personalised to individuals' preferences and life historyGood
responsive: Care plans reviewed regularly and updated to reflect changing needsGood
responsive: Complaints handled promptly and resolved in line with policyGood
well-led: Quality assurance systems not consistently applied; medicine and care plan audits incompleteRequires improvement
well-led: Failure to notify CQC of safeguarding incidents as required by regulationRequires improvement
well-led: Registered manager seen as approachable and supportive by staff and relativesGood
Caronne Care Ltd received an overall Good rating following a focused inspection of Safe, Effective and Well-Led domains, triggered by concerns about medicines management at its newly established supported living service. The registered manager responded promptly to all inspection findings, though recommendations were made regarding incident investigation best practice and adherence to Mental Capacity Act consent guidance.
Concerns (5)
moderateMedication management: “there had been times when medicine administration records were not correctly completed with regards to codes for administration being used.”
moderateInfection control: “On the first day of our inspection when we visited the supported living service staff were not following procedure with respect to PPE and checking visitors for signs and symptoms of COVID-19.”
minorIncident learning: “Safeguarding concerns were still recorded but witness statements were not always taken from all parties. This would be best practice.”
minorConsent / capacity: “two care plans consent agreements had not been signed by the person receiving care but by next of kin relatives supporting with care.”
minorRecord keeping: “one care support plan used the term "consent" in multiple places but was then not signed by the service user.”
Strengths
· Robust staff recruitment processes including references, employment histories and DBS checks.
· Electronic medicine administration system flagged gaps or missed doses in real time, auditing daily.
· Person-centred care plans with a focus on independence, equality characteristics and preferences.
· Responsive registered manager who acted immediately on inspection findings to rectify issues.
· Strong multi-agency working with social workers, nurses, GPs, pharmacies and healthcare professionals.
Quality-Statement breakdown (17)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing levelsGood
safe: Managing medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
Caronne Care Ltd received a Good rating across all five key questions at its December 2017 announced inspection, with all three breaches identified at the previous July 2016 inspection fully remediated. The service demonstrated safe medicines management, effective staff training and supervision, person-centred care planning, and robust quality assurance systems.
Concerns (3)
minorOther: “We noted that staff application forms asked prospective staff to provide details of their age and marital status. This was potentially discriminatory practice with regards to equality and diversity.”
minorRecord keeping: “one staff member had not been completing these [daily records] properly. This was discussed with the relevant staff member and improvements were made.”
minorCultural competency: “Assessments recorded people's ethnicity, preferred language and religion. They did not ask about people's sexuality including if people were Lesbian, Gay, Bisexual or Transgender (LGBT).”
Strengths
· Electronic monitoring system introduced to ensure staff punctuality and time compliance at visits.
· Robust staff recruitment processes including DBS checks, employment references and proof of identification.
· Medicines managed safely with signed administration record charts audited by senior staff.
· Staff received regular one-to-one supervision and ongoing training including the Care Certificate for new staff.
· Care plans were personalised, regularly reviewed and reflected individual needs and preferences.
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirementsGood
well-led: Continuous learning and improving careGood
well-led: Engaging and involving people using the service, the public and staffGood