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

Inspection report · 2021-10-30

Framework: KLOE · 17 pages · 86 KB · PDF

Requires improvement

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

Prime Care Associates received an overall rating of Requires Improvement at this May 2018 inspection, with breaches of Regulation 17 (good governance) due to inaccurate records, inadequate medication administration guidance, and ineffective audit processes. Caring, effective, and responsive domains were rated Good, reflecting kind and consistent staff, adequate training, and responsive complaint handling, though improvements remain needed in medicines management, care planning, and Mental Capacity Act compliance.

Concerns (8)

criticalMedication management: “directions for the applications of cream were not clear on the MAR's... the instruction on the MAR for the application of cream was "as directed"”
criticalRecord keeping: “Records were not always accurate and up to date. Where MAR charts did not have correct directions for administration the audit had not identified the shortfall.”
criticalGovernance: “findings of this inspection in relation to the areas identified for improvement were not consistent with audit log.”
moderateCare planning: “care plans were not developed where there were needs associated with the person's emotional, health and wellbeing. For example, how staff were to communicate with the person.”
moderateConsent / capacity: “care records were not clear on who made complex decisions for people that lacked capacity... relative did not have the legal authority to make these decisions.”
moderateMissed or late visits: “since January 2018 there were seven missed visits... missed visits were generally due to staff not looking at the rotas provided.”
moderateIncident learning: “Daily reports were not detailed on the repositioning changes that took place on each visit. This meant risks were not assessed and monitored.”
minorSafeguarding: “two staff were not clear on the types of abuse they knew to report their concerns.”

Strengths

· People told us they felt safe with the staff and staff knew procedures for safeguarding of vulnerable adults from abuse.
· Staff had access to a range of training including safeguarding, moving and handling, first aid and dementia.
· Staff were supported through spot checks, one-to-one supervision and annual appraisals.
· People told us staff were kind, caring and respected their rights, with continuity of care from familiar staff.
· Recruitment procedures ensured staff were suitable, including DBS checks and reference checks.

Quality-Statement breakdown (17)

safe: Medicine managementRequires improvement
safe: Risk assessment and managementRequires improvement
safe: SafeguardingGood
safe: Staffing and missed visitsRequires improvement
safe: RecruitmentGood
effective: Mental Capacity Act complianceRequires improvement
effective: Staff training and developmentGood
effective: Staff supervision and appraisalGood

Inspection report · 2021-10-30

Framework: KLOE · 17 pages · 87 KB · PDF

Requires improvement

safe: Requires improvementeffective: Requires improvementcaring: Goodresponsive: Requires improvementwell-led: Requires improvement

Prime Care Associates was rated Requires Improvement overall at its first rated inspection in February 2017, with weaknesses identified across medicines management, care planning, staff supervision, MCA/DoLS compliance, and governance auditing. The service was rated Good for caring, with strong evidence of compassionate, dignified care delivery and positive feedback from people, relatives, and community professionals.

Concerns (7)

criticalConsent / capacity: “Staff told us that bed sides were used for some people who lacked capacity to make decisions. These staff were not aware of having authorisation to deprive people of their liberty.”
moderateMedication management: “Protocols for when required (PRN) medicines and creams were missing and where they were in place, they lacked guidance on administration.”
moderateCare planning: “Care plans were not fully person centred as they did not give staff direction on how people liked their care needs to be met.”
moderateSupervision / appraisal: “Staff told us one to one meetings with their line manager to discuss concerns, training needs and personal development was not taking place.”
moderateGovernance: “Not all our findings had been identified for improvement within the audits. For example, supervision of staff and medicine systems.”
moderateStaffing levels: “Four visits were organised to take place between 12 noon and 1:15pm. This member of staff had to complete 25 visits in their eight hour shift.”
minorRecord keeping: “Some risk assessment action plans lacked person centred care, background history, and guidance on meeting people's needs in their preferred manner.”

Strengths

· People told us staff were kind, caring and respected their rights, with community professionals praising staff for going above and beyond their duty of care.
· Safeguarding training was mandatory and staff were able to identify potential abuse and knew their reporting responsibilities.
· Recruitment procedures were robust, including DBS checks and references before staff worked with people.
· Complaints were investigated and resolved satisfactorily, with no outstanding complaints at the time of inspection.
· Accidents and incidents were recorded and analysed for patterns to prevent reoccurrences.

Quality-Statement breakdown (16)

safe: Medicines managementRequires improvement
safe: Staffing rotas and visit schedulingRequires improvement
safe: Risk assessment and action planningRequires improvement
safe: SafeguardingGood
safe: RecruitmentGood
effective: Mental Capacity Act and Deprivation of Liberty SafeguardsRequires improvement
effective: Staff trainingRequires improvement
effective: Supervision and appraisalRequires improvement

Inspection report · 2019-08-16

Framework: KLOE · 18 pages · 100 KB · PDF

Good

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

Prime Care Associates achieved an overall Good rating at this August 2019 inspection, with improvements in medicine management and governance since the previous Requires Improvement rating. Safe remained Requires Improvement due to insufficient detail in risk assessments and absent mental capacity assessments for restrictive measures such as key safes and sensor equipment.

Concerns (5)

moderateCare planning: “The risk assessment for two people stated their skin integrity was compromised at times. The actions to take were brief and descriptions on the signs of skin breakdown needed more detail.”
moderateRecord keeping: “Where people smoked and had paraffin based topical creams risk assessments did not include the measures in place to reduce the potential of fire.”
moderateConsent / capacity: “Mental capacity assessments were not completed before some best interest decisions such as for people who had a sensor in place. Where key safes were used mental capacity assessments were not completed.”
minorSupervision / appraisal: “Another member of staff said there were spot checks, an annual appraisal but one to one supervision had not occurred.”
minorIncident learning: “There were no recorded accidents or incidents since 2017. The accident and emergency procedure were updated in 2017.”

Strengths

· People felt safe with staff and described staff as caring, compassionate and professional
· Medicine systems had improved with regular audits reducing recording errors
· Robust recruitment checks including DBS, references and proof of identity
· Comprehensive rolling programme of weekly audits covering HR, missed visits, daily notes, infection control, medicines and care planning
· Staff induction aligned to Skills for Care Certificate standards

Quality-Statement breakdown (21)

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 safelyGood
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)