Generixcare Luton is rated Good overall, having addressed previous breaches in staff recruitment and quality monitoring identified in August 2017. Well-led remains Requires Improvement due to ongoing inconsistency in care visit timings and gaps in end-of-life care planning for all service users.
Concerns (4)
moderate
Missed or late visits
: “Three people told us they had to cancel lunchtime visits because staff were not always able to arrive at their preferred times.”
moderateEnd-of-life care: “Only people requiring end of life care had these care plans...they needed to have this information for everyone they supported.”
minorCommunication with families: “Some people also commented about some of the staff not being able to communicate clearly in English...this did not promote more open and free conversations.”
minorGovernance: “Two people commented about the out of hours phone not always being answered. This is an area the provider needs to improve on.”
Strengths
· Effective risk assessments and safeguarding systems were in place to keep people safe from abuse or harm.
· Safe staff recruitment processes had been improved since the previous inspection in August 2017.
· Medicines were managed safely with regular MAR audits and no unexplained gaps identified.
· Staff received regular supervision, support and mandatory training to meet people's individual needs effectively.
· People were supported by caring, friendly and respectful staff who promoted independence, privacy and dignity.
Generixcare Luton was rated Requires Improvement overall following a focused inspection of Safe and Well-Led, with breaches of Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) identified. Key failures included late and shortened care calls causing direct harm to people, inadequate risk assessments, poor staff competency in medicines and safeguarding, and failure to report notifiable incidents to CQC.
Concerns (10)
criticalMissed or late visits: “being left from 6pm until 11 am without food, being placed at risk of pressure damage from being in bed too long, time critical medication and food being late”
criticalStaffing levels: “Records showed some occasions where calls were cut short to as little as five minutes for a call intended to last 30 minutes.”
criticalStaff competency: “some staff we spoke with did not have good understanding of what different types of abuse were or how to report these outside of the service.”
criticalGovernance: “The provider had not always reported notifiable events to the care quality commission as required.”
criticalSafeguarding: “Following the inspection we raised our concerns about the impact of late and short calls to the local authority safeguarding team.”
moderateCare planning: “one person's assessment suggested staff must, 'try to support the person using pillows'. This instruction could mean something different to each member of staff”
moderateMedication management: “records of some checks were not detailed to show how the assessor had come to the judgement that the staff member was competent in this area”
moderateSupervision / appraisal: “Competency checks, spot checks and feedback records on the performance of new staff were not always completed in enough detail.”
moderateStaff training: “People told us they were not confident that agency and newer staff had received sufficient training to carry out their role safely.”
moderateRecord keeping: “Another risk assessment was inaccurately completed resulting in an incorrect level of risk being identified.”
Strengths
· Staff had access to sufficient PPE and received COVID-19 infection control training including weekly testing.
· Appropriate pre-employment checks including criminal record checks and references were obtained for all staff.
· The provider maintained an open and honest culture and was receptive to inspection feedback.
· The service worked proactively with other health and social care providers to ensure good outcomes for people.
· Learning from incidents and complaints was shared via team meetings, supervision and staff communication channels.
Quality-Statement breakdown (9)
safe: Staffing and recruitment; Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Continuous learning and improving care; duty of candour
Generixcare Luton required improvement overall due to breaches of Regulations 17 and 19, with ineffective recruitment processes including missing DBS risk assessments and absent references, and insufficiently robust governance and record-keeping systems. The service performed well in effective, caring and responsive domains, with staff demonstrating kindness, appropriate training and person-centred practice.
Concerns (6)
criticalStaffing levels: “The provider did not have effective staff recruitment processes to ensure that staff were suitable for their roles. There were missing references.”
criticalSafeguarding: “The registered manager had not completed a risk assessment when information of concern had been highlighted in one member of staff's DBS report.”
moderateGovernance: “Although the provider completed audits, they did not have robust systems to drive continual and sustained improvements.”
moderateRecord keeping: “Some of the records were not up to date which meant that information was not always kept in an accessible manner.”
moderateLeadership: “The registered manager was at the time of the inspection, the sole person responsible for planning and reviewing people's care, supporting and monitoring staff.”
minorMissed or late visits: “Information about changes in rotas was not always communicated well resulting in some missed or late visits.”
Strengths
· Effective safeguarding systems and staff training on how to keep people safe from abuse and harm
· Sufficient staffing levels with consistent visit plans met and timely arrivals reported by people
· Medicines managed safely with completed MAR sheets and competency assessments for staff
· Staff received ongoing training, supervision and support including specialist training (e.g. stoma care)
· Mental Capacity Act 2005 requirements were being met and people consented to their care