Community Care Worker Limited, a domiciliary care provider in Stoke-on-Trent serving 101 people, remained Inadequate across safe, effective and well-led domains at this July 2022 focused inspection, with continued breaches of Regulations 11, 12, 13, 17 and 18. Persistent failures included unsafe medicines management, missed and shortened care calls, inadequate staff training, ineffective governance, and a diversion of office calls to an undisclosed overseas call centre, leaving the service in special measures with a risk of registration cancellation.
Concerns (16)
criticalSafeguarding: “Staff administered one person's medicine without leaving the required time gap between dosages. This posed a risk of harm to the person. We reported this to the local safeguarding team.”
criticalMedication management: “Some people's medicines were administered without the correct recording documentation in place. This included prescribed creams and pain relief.”
criticalMissed or late visits: “Some people received calls lasting just one, three or 13 minutes when they should have 30 minutes. There was no information to state why people did not receive their full amount of time.”
criticalStaffing levels: “Staff told us there were insufficient numbers of staff to meet people's needs. One staff member told us, 'They are taking on too many clients for the staff to cope.'”
criticalStaff training: “Staff completed 22 care related topics in one day... Records showed staff also completed the Care Certificate on the same date. Some staff told us they had no recollection of having completed this course.”
criticalCare planning: “Some people had catheters with no plans in place to help staff provide safe catheter care... Some people's care plans did not identify they even had a catheter.”
criticalGovernance: “Although audits were completed on people's care and records, they had not identified the concerns and errors we identified.”
criticalRecord keeping: “Staff who completed the medicine audits had amended administration records, so it showed people had received their medicine. Some of these records were amended over six weeks later.”
criticalConsent / capacity: “One person lacked capacity to consent to their care. Best interest decisions had not been made and the management team did not know whether or not the relative had the lasting power of attorney.”
criticalLeadership: “Since the provider registered with us in 2015, we have inspected them nine times. On only one inspection have they been rated as good.”
moderateStaff competency: “Not all staff who supported people with a learning disability had received appropriate training. The registered manager told us they were currently developing a training session.”
moderateInfection control: “Six of these staff did not change their mask in accordance with the current Government guidance. This placed people at risk of catching infections, such as COVID-19.”
moderateSupervision / appraisal: “The area manager acknowledged staff supervision and observation of their practice had not been completed regularly but they were now getting back on track with these.”
moderateIncident learning: “Despite actions taken in response to incidents we were not assured the provider had learnt lessons... specific and individual actions taken but these did not feed into the wider service to help identify themes.”
moderateCommunication with families: “Telephone calls made to the provider's Stoke-on-Trent office were diverted to their office in Bangladesh. The registered manager had not informed people or relatives about this.”
moderatePerson-centred care: “People's protected characteristics, as identified in the Equality Act 2010 were not always outlined in their care plans. This included gender, age, culture, religion, ethnicity and disability.”
Strengths
· When people had regular care staff, they considered the service they received to be good and some staff described as excellent.
· The provider worked with other health professionals such as GPs, district nurse teams and social workers to support people's care needs.
· Evidence of concerns raised by relatives being acted upon, including spot checks on staff PPE compliance.
· One person noted a regular carer who went 'above and beyond', supporting with walking and ensuring eating and drinking.
Quality-Statement breakdown (15)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
safe: Staffing and recruitmentInadequate
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceInadequate
effective: Ensuring consent to care and treatment in line with law and guidanceInadequate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
Community Care Worker Limited improved from Inadequate to Requires Improvement across Safe, Effective and Well-led following a focused inspection, with all prior regulatory breaches remediated. Remaining concerns centre on incomplete training and recruitment records, inconsistent quality monitoring engagement with all service users, and a language barrier with some staff.
Concerns (6)
moderateRecord keeping: “provider acknowledged the records did not fully reflect the actions they are taking”
moderateStaff training: “staff members were completing excessive courses in 1 day and the records did not make it clear when competency assessments had been completed”
moderateStaff competency: “records did not make it clear when competency assessments had been completed. The provider spent time showing us how they managed training”
moderateGovernance: “there were still areas where systems and processes used did not evidence all the work undertaken. For example, the training records and recruitment records.”
minorCommunication with families: “a number of people told us there was an occasional language barrier, especially with new staff but all staff were polite”
minorPerson-centred care: “Not all people had received them yet but of those which had been completed, the feedback did reflect the positive changes over the past 6 months.”
Strengths
· Improvements made to safeguarding systems and risk monitoring since last inspection; no longer in breach of Regulation 13
· Call times improved with no missed calls reported; majority of late calls within local authority thresholds
· More consistent staffing with staff working set geographical areas, reducing stress for staff and people
· Medicine management improved through engagement with NHS medicines optimisation team; errors investigated and lessons learnt
· Infection control practices met current guidance; sufficient PPE stock available to staff
Quality-Statement breakdown (15)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills, and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
Community Care Worker Limited was rated Inadequate overall following a focused inspection in July–August 2021, with breaches of Regulations 12, 13, 17 and 18 identified across safe care and treatment, safeguarding, governance, and staffing. Critical failures included unaddressed safeguarding concerns, widespread missed and under-staffed double-up calls, unsafe medicines administration, and wholly ineffective quality assurance systems, placing the service into special measures.
Concerns (10)
criticalSafeguarding: “one person had bruises and a possible bite mark which had not been checked on...staff had reported concerns about family members allegedly abusing people.”
criticalMissed or late visits: “one person who had double-up calls was visited by 50 different staff in a one-month period.”
criticalMedication management: “One staff member was sent out and expected to administer medicines to two different people, however they had not been trained to carry out this task.”
criticalStaffing levels: “There were not enough staff to safely cover every person's planned calls, particularly those who needed two staff to attend each call.”
criticalGovernance: “Quality assurance systems were not effective at identifying concerns or areas for improvement therefore the provider could not demonstrate they were continuously learning.”
moderateStaff training: “Staff did not always receive sufficient training to be effective and feel confident in their role.”
moderateIncident learning: “The record of the investigation was poor, with lack of detail about what had gone wrong and what had been investigated.”
moderateCommunication with families: “The communication is a nightmare I'm sorry to say. If I phone and ask them for something, they say they'll call you back and they never call back.”
moderateRecord keeping: “some plans referred to other people's names and needs so we could not be sure they were always personalised. This had not been identified by the provider.”
minorConsent / capacity: “some people who had relatives recorded as either giving consent...without the relevant legal authority being evidenced.”
Strengths
· Staff wore appropriate personal protective equipment (PPE) such as masks, gloves and aprons during visits.
· People were supported to access food and fluids when needed as part of their care.
· Care plans were detailed, providing staff with guidance about how people liked to be supported.
· Staff understood people's right to make their own decisions and assumed capacity appropriately.
· The provider engaged an external consultant to assist with improvement and was proactive in writing to people affected by missed calls.
Quality-Statement breakdown (12)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidance
This targeted inspection of Community Care Worker Limited found a continued breach of Regulation 12, with people not consistently receiving medicines as prescribed due to inaccurate records, incorrect dosing frequencies, and absent guidance for transdermal patches. The overall rating remains Inadequate and the service continues in special measures.
Concerns (5)
criticalMedication management: “One person was prescribed medicine for their diabetes twice a day, however staff were administering this three times daily. This placed them at risk of harm.”
criticalMedication management: “One person was prescribed ibuprofen 200mg. However, this had been recorded on their medicines records as 500mg. Staff had signed to say they had administered this dose.”
criticalMedication management: “One person was prescribed medicine for pain relief which required doses to be spaced 12 hours apart. However, they did not always receive this medicine at the correct time.”
criticalRecord keeping: “People did not always have doses of medicines recorded on the medicine records. This meant there was not always guidance in place for staff to ensure people received their medicines as prescribed.”
moderateMedication management: “When people received their medication via a trans-dermal patch the provider had failed to ensure there was sufficient guidance in place around where patches should be placed.”
Strengths
· The provider responded immediately during and after the inspection, involving other health professionals to reduce risk to people identified as at risk of not receiving medicines safely.
· The provider took action to make improvements to medicines records and the support provided by staff completing these.
Quality-Statement breakdown (1)
safe: Using medicines safelyInsufficient evidence to rate
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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 dietRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportGood
well-led: Continuous learning and improving care; Working in partnership with othersGood
well-led: Engaging and involving people using the service, the public and staffRequires improvement
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 empoweringGood
Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
well-led: Continuous learning and improving care; Working in partnership with othersInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate