ReadyCQC, a weekly field guide to CQC home-care regulation

Inspection report · 2023-04-28

Framework: KLOE · 17 pages · 97 KB · PDF

Inadequate

safe: Inadequateeffective: Requires improvementcaring: Requires improvementresponsive: Requires improvementwell-led: Inadequate

5 Care Services Limited received an overall Inadequate rating following a January 2023 inspection, with breaches of Regulations 9, 12 and 17 identified relating to unsafe risk management, absent care planning, persistent late calls, poor medicines oversight and wholly ineffective governance. The service was placed in special measures, with the provider failing to address the same catheter care and risk assessment shortfalls identified at the previous 2019 inspection.

Concerns (13)

criticalCare planning: “One person was a known risk of choking and required meals prepared in a specific way. There was no specific care plan in place to guide staff when preparing meals.”
criticalSafeguarding: “care staff were often late which led to their relation experiencing periods of incontinence.”
criticalMedication management: “clear written guidance was not always in place for when to offer people medicines which were prescribed on an 'as and when required' basis (PRN medicine).”
criticalStaffing levels: “The registered manager had not always allocated enough time between calls to ensure people received timely care. This meant people did not always receive the care they required when needed.”
criticalMissed or late visits: “one person told us, '[Care staff] are too late, I need to go to bed.' Another person told us, 'I've had to complain as [care staff] are always late.'”
criticalIncident learning: “when a person fell in the presence of care staff, there was no analysis of the incident or attempts made to mitigate the risk of reoccurrence.”
criticalGovernance: “The provider failed to implement an audit schedule or quality assurance policy and procedure. There was no monitoring or audits of care call times, medicine administration or people's care plans.”
criticalRecord keeping: “People's risk assessments had not been updated or reviewed following accidents or incidents. One person had a history of falls and had recently fallen in the presence of care staff. No risk assessment or care plan was in place.”
moderateSupervision / appraisal: “Most staff told us they did not receive regular supervision. One member of staff told us, 'I've not had a supervision since I've been working here.'”
moderatePerson-centred care: “Assessments completed for people were basic and did not always incorporate key information, such as their life history, wishes, preferences or protected characteristics.”
moderateComplaints handling: “1 person told us, 'I've complained before, but they don't listen to you.' Another person told us, 'I've complained about the time care staff come but [the provider] doesn't listen to me.'”
moderateLeadership: “Most care staff we spoke with told us there was a poor culture within the service. Some staff told us they would not recommend working for the provider and were actively looking for a new job.”
moderateCommunication with families: “Care plans included very little information about the persons communication needs reading, '[Person] is unable to communicate.' There was no other information made available to staff.”

Strengths

· Staff recruited safely with pre-employment checks including DBS, conduct in previous roles, experience and qualifications completed.
· People and relatives reported staff treated them with kindness, compassion, dignity and respect during care visits.
· Staff had completed mandatory training including safeguarding, mental capacity and moving safely.
· New care staff completed induction programme and the Care Certificate.
· Staff wore appropriate PPE and were trained in infection prevention and control.

Quality-Statement breakdown (20)

safe: Assessing risk, safety monitoring and managementInadequate
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Learning lessons when things go wrongInadequate
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to live healthier lives and working with other agencies

Inspection report · 2022-10-07

Framework: KLOE · 15 pages · 90 KB · PDF

Requires improvement

safe: Requires improvementeffective: Goodcaring: Goodresponsive: Goodwell-led: Requires improvement

5 Care Services Limited was rated Requires Improvement overall at its July 2019 inspection, down from Good in 2016, primarily due to gaps in risk assessments, missing allergy information on medication records, and insufficient travel time allocated between care calls. The provider had already recognised these shortfalls and taken remedial action by engaging a compliance manager and consultant, with improvements underway at the time of inspection.

Concerns (5)

moderateCare planning: “one person did not have a risk assessments in place in relation to catheter care or how staff managed people's behaviour”
moderateGovernance: “staff told us when they contact the office staff it can take as long as 20-30 minutes for the office staff to return their call”
moderateMissed or late visits: “some calls was twenty-five minutes away from each other, the five minute travel allowance was not sufficient to ensure people had their call on time”
moderateRecord keeping: “registered manager told us developments were being made to people care records... more information was needed”
minorMedication management: “information about people's allergies had not been included on the medication administration records for ease of reference in the event of an emergency”

Strengths

· People felt safe with staff and staff were aware of safeguarding procedures and how to report concerns
· Staff underwent thorough recruitment including DBS checks and worked with experienced staff before supporting people alone
· People received consistent care from familiar staff where possible
· Staff had relevant skills, training including Care Certificate, and understood people's individual needs and preferences
· People were involved in planning and reviewing their care and treated with dignity and respect

Quality-Statement breakdown (24)

safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood

Inspection reports (4)