Care Hand Service Ltd, a small domiciliary care agency specialising in care for deaf and multi-sensory impaired people, was rated Good overall following significant improvements since its previous Requires Improvement rating in June 2017. The service was rated Requires Improvement for safety due to ongoing inconsistencies in medication administration records and ineffective medicines auditing, though the provider took prompt remedial action following the inspection.
Concerns (3)
moderateMedication management: “we found that there were occasions where there were inconsistencies in the completion of MARs. We found that there were occasions where there were gaps in MARs”
moderateMedication management: “the service did not have an effective medicine administration audit in place. There were gaps and inconsistencies in a sample of MARs we looked at and we noted that this was not identified in a medicines audit”
moderateGovernance: “the service had failed to regularly and effectively check medicine administration records”
Strengths
· All care workers were registered deaf and able to communicate in BSL, enabling effective communication with people using the service
· Service had made significant improvements since previous inspection including risk assessments, care documentation, staff training and supervision
· Telelogging system introduced to effectively monitor care worker punctuality and attendance
· Care plans were person-centred, detailed and specific to each person including cultural, spiritual and communication needs
· Sufficient staffing levels with consistent care workers assigned to people, ensuring continuity of care
Quality-Statement breakdown (10)
safe: Medicines managementRequires improvement
safe: Risk assessmentsGood
safe: SafeguardingGood
safe: Staffing and recruitmentGood
effective: Staff training and supportGood
effective: Mental Capacity Act complianceGood
caring: Dignity, respect and person-centred careGood
responsive: Care planning and individual needsGood
responsive: Complaints handlingGood
well-led: Governance and quality monitoringRequires improvement
Care Hand Service Ltd, a small domiciliary care agency specialising in deaf and multi-sensory needs, was rated Requires Improvement overall at its first inspection in June 2017, with three regulatory breaches identified covering unsafe risk assessments, failure to complete MAR records, and insufficient staff training and supervision. The service demonstrated genuine strengths in its person-centred, BSL-competent workforce and caring approach, but lacked the governance and oversight systems needed to identify and address its own failings.
Concerns (6)
criticalCare planning: “risk assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments”
criticalMedication management: “the service was not completing Medication Administration Records (MARs) when administering medicines to people. People were therefore at risk of not receiving their medicines safely”
criticalGovernance: “the service did not have effective systems and processes in place to assess, monitor and improve the quality of the services provided”
moderateStaff training: “no evidence to confirm that three out of six members of staff had received further training other than the induction they received when they started working at the service”
moderateSupervision / appraisal: “there was a lack of evidence to confirm that staff had received supervision sessions”
moderateRecord keeping: “there was a lack of consistency in the care records we looked at. We found that the quality of care documentation varied in each of the care plans we looked at”
Strengths
· Majority of care workers were registered deaf and able to communicate in BSL, enabling effective communication with people using the service
· People experienced consistency in care through regular, familiar care staff
· Safeguarding policies and procedures were in place with whistleblowing policy and contact numbers
· Care plans were individualised, addressing personal care, daily tasks, visit times, people's needs and preferences
· Staff demonstrated awareness of privacy, dignity and promoting people's independence
Quality-Statement breakdown (13)
safe: Risk assessmentsRequires improvement
safe: Medicines managementRequires improvement
safe: SafeguardingGood
safe: Staffing levels and recruitmentGood
effective: Staff trainingRequires improvement
effective: Supervision and appraisalRequires improvement
effective: Mental Capacity Act / consentGood
caring: Dignity, respect and privacyGood
caring: Person-centred approach
Good
responsive: Care plan quality and consistencyRequires improvement
responsive: Complaints handlingGood
well-led: Quality assurance and auditingRequires improvement
well-led: Management culture and accessibilityGood