This focused inspection of Bucks Country Home Care Limited found the service had successfully addressed a previous breach in medicines management and improved from Requires Improvement to Good overall. Minor gaps remained in risk assessment detail for complex medical conditions and in documentation for medicines prescribed for occasional use.
Concerns (2)
minorMedication management: “we found the details could be further improved to ensure people who were unable to verbally consent were supported by staff who had additional guidance on when the medicine should be given”
minorCare planning: “we found some guidance for staff had been omitted with this change... more in-depth detail was required to ensure the person's safety”
Strengths
· Medicines administration improved since previous inspection; no longer in breach of Regulation 12
· Staff recruited safely with full pre-employment checks including DBS, references and employment history
· Good supply and use of PPE; staff engaged in COVID-19 testing and vaccination programme
· Accidents and incidents recorded and reviewed to prevent recurrence
· Registered manager open and transparent; duty of candour requirements met
Bucks Country Home Care Limited received a Good rating across all five key questions at its first CQC inspection in April 2017, with people and relatives highly positive about the quality and reliability of care. Minor recommendations were made regarding medicine management auditing and staff understanding of the Mental Capacity Act.
Concerns (4)
moderateMedication management: “A senior office member of staff undertook a medicine review; however these did not always pick up omissions on the MARs.”
minorMedication management: “Where medicine administration was shared with family member it was not always clear which dose was administered by whom.”
minorConsent / capacity: “Care workers we spoke with were unable to fully provide us with their understanding of how it affected the way they worked with people.”
minorGovernance: “It did not always use information gathered at reviews to drive improvement.”
Strengths
· People expressed high satisfaction with care, describing staff as 'fabulous', 'wonderful' and 'thoroughly professional'.
· Robust recruitment processes including DBS checks, employment history and references for all care workers.
· Care workers provided with adequate travel time between calls and were not rushed, supporting safe care delivery.
· Comprehensive, personalised care plans detailed enough for unfamiliar staff to provide appropriate care.
· Stable workforce with strong team culture; care workers felt valued and well-supported by management.
Bucks Country Home Care Limited was rated Requires Improvement overall at its November 2019 inspection, having deteriorated from Good, primarily due to a breach of Regulation 12 concerning unsafe medicines administration record-keeping. The service demonstrated genuine strengths in caring, responsiveness and staff conduct, but governance failures around medicine management and the absence of a registered manager undermined safety and leadership.
Concerns (5)
criticalMedication management: “We found prescribed medicines were not always routinely listed on MARs. For instance, antibiotics and eye drops had been administered by staff, without any written guidance on the MAR.”
criticalRecord keeping: “We found no MAR chart in place for one person for a period of six days. Daily records showed care workers had administered prescribed medicines to the person for the same period.”
moderateGovernance: “The provider's governance systems had not identified the service was not routinely following national guidance with respect of safe medicines administration.”
moderateLeadership: “At the time of the inspection there was a manager registered with the CQC, however they were no longer in post and an application to remove them was being processed.”
minorEnd-of-life care: “We observed end of life wishes had not been recorded in people's care plans. This meant people may not have been given the opportunity to discuss their end of life needs and preferences.”
Strengths
· Staff demonstrated kindness, compassion and promoted people's dignity, with people commenting 'They respect my privacy at all times' and 'They're really lovely'.
· Safe recruitment practices were in place including DBS checks, employment history and references.
· Good communication between office staff and care workers, with timely and appropriate referrals to external healthcare professionals.
· People's care plans detailed their likes, dislikes, cultural needs and communication requirements in a personalised way.
· Complaints were responded to in a timely manner and used to learn and develop the service.
Quality-Statement breakdown (24)
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
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
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; Working in partnership with othersGood