Achieve Together's Domiciliary Care Agency East Area received an overall rating of Requires Improvement following a focused inspection across safe, responsive and well-led domains, with three regulatory breaches identified relating to staffing, risk management and governance. Significant inconsistencies were found between supported living settings, with Willoughby Services presenting the most serious concerns around staffing levels, infection control, complaints handling and a prolonged absence of consistent registered management.
Concerns (9)
criticalStaffing levels: “Staffing rotas showed that Willoughby Services was not always staffed at the safe levels set by the provider, during both the day and night.”
critical
Staff training
: “Not all staff had completed the training necessary to meet people's needs...positive behaviour support, epilepsy awareness, specialist epilepsy medication, dysphagia and autism training.”
criticalGovernance: “The provider had failed to assess, monitor and improve the quality and safety of the service. This was breach of regulation 17 (2) of the Health and Social Care Act 2008.”
moderateInfection control: “Some areas of Willoughby Services were not clean, including a mouldy shower curtain, unclean bedding and a damp smelling bathroom with stained flooring.”
moderateLeadership: “There had been numerous changes in the management of the service in the previous 12 months...at service manager level, manager level and regional manager level.”
moderateComplaints handling: “We reviewed 3 complaints that had been received by Willoughby services. Only one of the 3 had been investigated and responded to in line with the provider's policy.”
moderatePerson-centred care: “The level of person-centred care that people received was not consistent across all of the supported living settings.”
moderateIncident learning: “Audits of quality and safety were not always completed as they should have been, which meant that lessons were not always learnt, and improvements made in a timely way.”
minorRecord keeping: “Medicines stock levels and records were not consistently checked by management. We were told medicines audits were not available for Willoughby Services.”
Strengths
· Staff were recruited safely with appropriate pre-employment checks carried out before staff started working.
· Staff communicated with people in ways that met their individual communication needs.
· People's care plans were detailed and included information about individual risks, needs and preferences.
· Safeguarding incidents were investigated and reported to the local authority and CQC when appropriate.
· At Helena Services, The Stables and Kings Ripton Services, staff and management learnt from complaints, incidents and audits.
Quality-Statement breakdown (14)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and management; Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongRequires improvement
responsive: Planning personalised care; Supporting relationships; Support to follow interests and activitiesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportGood
well-led: Managers and staff roles, quality performance, risks and regulatory requirements; Continuous learningRequires improvement
well-led: Engaging and involving people, the public and staffRequires improvement
well-led: Promoting a positive, person-centred, open and inclusive cultureRequires improvement
A focused inspection following concerns found the service had deteriorated from Good to Requires Improvement across Safe, Caring and Well-Led, with lapses in COVID-19 infection control, isolated breaches of dignity, and inconsistent governance across local services. Despite these shortfalls, staff demonstrated kind, person-centred support and the registered manager responded candidly and promptly to address identified issues.
Concerns (8)
moderateInfection control: “in one local service, some staff did not always wear a face mask, increasing the risk of transmission of COVID-19.”
moderateInfection control: “in one local service, staff failed to ask our inspector for proof of a recent COVID-19 test, increasing risks to people and staff.”
moderatePerson-centred care: “the staff member then walked into the room without waiting for a response, to find the person was getting dressed after a shower, compromising their privacy.”
moderatePerson-centred care: “another member of staff used the disrespectful term 'boys', to describe two adult men who used the service.”
moderateGovernance: “organisational governance was not consistently effective across the service and people did not always receive safe care and support.”
moderateLeadership: “The provider had failed to establish a wholly consistent culture of care across the service.”
minorCare planning: “staff gave greater consideration to identifying people's sexual needs and preferences, as this area was generally under-documented in people's individual support plans.”
minorMedication management: “the registered manager took action to improve medicine stock control checks in response to an issue we identified in one local service.”
Strengths
· Comprehensive and well-organised approach to care planning and individual risk assessment, with detailed person-centred records.
· Staff implemented STOMP principles, reducing inappropriate use of medicines for people with learning disabilities and autism.
· Sufficient appropriately skilled staff despite COVID-19 pressures, with safe recruitment checks in place.
· Staff showed warmth, compassion and creativity in supporting people to develop independence and pursue interests.
· Strong communication skills enabling staff to understand people's individual ways of communicating.
Quality-Statement breakdown (12)
safe: Preventing and controlling infectionNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Learning lessons when things go wrongNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversity