Denise Quality Care Services Limited was rated Inadequate overall following a June 2017 inspection, with breaches across six regulations including safeguarding, safe care, recruitment, staffing, person-centred care, and governance. The service was placed in special measures due to critical failures including an unvetted individual found providing care, absent supervision and training systems, and a complete lack of effective provider oversight.
Concerns (11)
criticalSafeguarding: “staff were concerned for a person's wellbeing in terms of a relative's interventions. No attempt had been made by staff to discuss this with management”
criticalStaffing levels: “a 'staff member' was working for the service that had not been recruited at all”
criticalMedication management: “staff were signing medication records where covert medication was being given by the family without witnessing the medication being placed in food”
criticalStaff training: “staff had not received specific training relating to catheter care...instruction had been given by other members of staff who were not trained to deliver this specific training”
criticalGovernance: “provider had failed to implement a robust quality monitoring system that operated effectively to ensure compliance with regulatory requirements”
moderateSupervision / appraisal: “It is hoped that supervisions will be held four times a year but none have been done as of yet...appraisals had not been completed at this time”
moderateCare planning: “People's support plans did not include information on how people would be supported to meet their assessed needs”
moderateRecord keeping: “Care records for people did not contain information on people's preferences and choices fully or clear instructions on how staff would meet people's needs”
moderatePerson-centred care: “No evidence was available to show that the content of the support plans had been agreed with the person who used the service or those acting on their behalf”
moderateStaff competency: “registered manager could not evidence that staff were assessed following the training to ensure they were competent or to see if the training had been effective”
moderateConsent / capacity: “there had been no training on the Mental Capacity Act 2005 for staff...none of the staff were able to demonstrate an understanding of the requirements”
Strengths
· People told us they felt safe and staff were described as reliable and punctual
· People received their medicines at the times they needed them
· Staff demonstrated a good knowledge and understanding of the people they cared for
· People's nutritional and healthcare needs were identified and support provided
· People reported their privacy and dignity were maintained during personal care
Denise Quality Care Services Limited improved significantly from its previous Inadequate rating, with the support of the Local Authority, achieving Good in effective, caring and responsive domains. Overall and safe and well-led ratings remain Requires Improvement as the provider must demonstrate it can sustain safe, high-quality care independently as it grows.
Concerns (3)
moderateGovernance: “the provider will need to demonstrate that their quality assurance and safety processes are robust enough to sustain good quality care delivery over time and independently of external support”
moderateLeadership: “this key question will remain as Requires Improvement, so the provider can evidence over time that they can independently and robustly monitor and manage the service as it expands”
minorRecord keeping: “We hadn't realised how much we had fallen behind in regards to what is required to evidence good care.”
Strengths
· Significant improvements made in recruitment processes since previous inadequate rating, including DBS checks, references and identity verification
· Medication Administration Records correctly completed with no unexplained gaps; medication storage boxes installed in each person's home
· Staff received regular supervision at least monthly and yearly appraisals, documented in staff files
· Care plans personalised and reviewed to reflect individual needs, preferences and risk assessments
· Strong person-centred culture with people supported to maintain independence and community access
Quality-Statement breakdown (16)
safe: Risk assessment and recordingRequires improvement
Kanmore House is a small domiciliary care agency rated Good across all five key questions at its May 2019 inspection, representing an improvement from the previous Requires Improvement rating. Minor shortfalls were noted in medicines record-keeping, care plan detail, and consent documentation, with a recommendation issued regarding medicines management best practice.
Concerns (4)
moderateMedication management: “care plans and daily record notes were not always clear, and we could not determine whether staff had prompted or administered people's medicines. MAR had been completed however this had not been done in line with best practice.”
minorCare planning: “some care plans did not always contain detailed guidance for all aspects of people's care needs, including managing any associated risks; for example, catheter care.”
minorConsent / capacity: “people had not signed their care plans to show they consented to their care and support.”
minorPerson-centred care: “With the exception of sexuality needs, people's equality and diversity needs were identified and recorded in care plans. The provider told us they would update care plan documentation to include people's sexuality needs.”
Strengths
· People felt safe and staff understood safeguarding responsibilities, with appropriate training in place.
· Safe recruitment practices and consistent staffing ensured continuity of care for people.
· Staff received regular supervision, appraisal, induction and training to meet people's needs effectively.
· Care plans were person-centred, regularly reviewed, and reflected people's preferences and backgrounds.
· People and relatives provided overwhelmingly positive feedback about the kindness and dignity shown by staff.
caring: Dignity, respect and compassion
Good
caring: Involvement in care planningGood
caring: Communication with familiesGood
responsive: Person-centred care planningGood
responsive: Promoting independence and community accessGood
responsive: Complaints handlingGood
well-led: Quality assurance and audit systemsRequires improvement
well-led: Leadership and management oversightRequires improvement