Wishes Care and Support Yorkshire improved from Requires Improvement to Good following breaches of Regulations 12, 17 and 18 at the previous inspection, with effective remediation across risk management, safeguarding, medicines, staffing and governance. The remote inspection found a well-led service delivering safe, person-centred care to 163 people in their own homes.
Strengths
· Personalised, regularly reviewed care plans and risk assessments in place to reduce risks
· Medicines managed safely with staff training, competency checks and regular audits
· Effective safeguarding systems and trained staff; people reported feeling safe
· Sufficient staffing levels achieved through recent recruitment with thorough vetting procedures
· Regular audits and governance processes in place; provider no longer in breach of Regulations 12, 17 or 18
Wishes Care and Support Yorkshire was rated Requires Improvement overall following a focused inspection prompted by safety concerns, with breaches of Regulation 12 (Safe care and treatment), Regulation 17 (Good governance), and Regulation 18(2) for failure to notify CQC of reportable incidents. While medication administration, infection control and recruitment were managed well, the provider lacked oversight, failed to learn from incidents, and had ineffective safeguarding systems.
Concerns (10)
criticalGovernance: “The failure to establish effective systems to assess, monitor and improve the quality and safety of the service and mitigate risks was a breach of Regulation 17”
criticalIncident learning: “The provider did not complete any analysis of accidents and incidents to identify areas of concern and use this information improve the safety of the service.”
criticalSafeguarding: “Systems and processes to safeguard people from the risk of abuse were ineffective.”
criticalLeadership: “There was no oversight by the provider or registered manager in relation to the quality and safety of the service.”
criticalRecord keeping: “The provider had failed to notify the CQC of multiple reportable incidents including allegations of abuse.”
criticalCare planning: “The provider had not altered risk assessments in a timely manner following incidents, placing people at increased risk of harm.”
criticalOther: “Medical attention was not always sought in a timely manner following falls, placing people at increased risk of harm.”
moderateMissed or late visits: “People told us that their care visits were often late and felt this was down to a lack of staff.”
moderateStaffing levels: “Relatives told us they had been asked to step in to provide care when staffing numbers were low.”
moderateStaff training: “The provider were unable to produce records to confirm staff had received appropriate training in the safe care and support for people with a percutaneous endoscopic gastrostomy (PEG).”
Strengths
· Staff were recruited safely and attended a full programme of induction
· People told us their care staff were kind and considerate, they told us they felt safe
· Staff received training in the safe administration of medicines and their competency was checked regularly
· Provider was assured to be using PPE effectively and following infection prevention and control measures
· Provider regularly engaged with people who use the service to check satisfaction
Quality-Statement breakdown (8)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Working in partnership with others; Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood