Home Instead Senior Care (Calderdale & Spen Valley) was rated Requires Improvement overall at this September 2018 inspection, with continuing breaches of Regulation 12 (medicines management and risk assessment) and Regulation 17 (governance and record keeping) from the previous inspection. Caring was rated Good, with people reporting kind, respectful and flexible support, but significant weaknesses remained across safety, effectiveness, responsiveness and leadership.
Concerns (9)
criticalMedication management: “Some medicines did not specify the dose required on the MARs. Additional medication was handwritten on the MARs but these were not signed by staff or signed by a second member of staff.”
criticalMedication management: “One person was receiving their medicines covertly...there was no evidence a pharmacist had been involved in this process...no evidence to show guidance had been sought from a pharmacist.”
criticalCare planning: “Two of the three care plans reviewed were for people who were regarded as end of life. However, the care plans made no reference to any end of life plans, preferences or contact details.”
criticalGovernance: “The provider did not have adequate systems and processes for assessing and monitoring the quality of the service...breach of Regulation 17 of the Health and Social Care Act 2008.”
moderateRecord keeping: “Accurate and contemporaneous records were not kept for each service user. Care records did not clearly show the number of calls a person required, the purpose of the call or the call times.”
moderateSupervision / appraisal: “There was no supervision matrix in place to show staff had planned supervisions scheduled. We saw only a limited amount of staff had received formal supervisions in the last five months.”
moderateIncident learning: “There was no system in place to monitor for patterns and trends over a period of time...no detailed analysis undertaken for patterns and trends over a set time period.”
moderateEnd-of-life care: “Two of the three care plans reviewed were for people who were regarded as end of life. However, the care plans made no reference to any end of life plans, preferences or contact details.”
moderateCare planning: “A care file of a person who had started using the service two weeks ago did not contain any risk assessments despite the person receiving catheter care.”
Strengths
· People told us they felt safe using the service and with staff; safeguarding incidents were recorded and responded to appropriately.
· Staff recruitment records demonstrated appropriate scrutiny including DBS checks and references prior to providing care.
· Minimum one-hour calls allowed staff to build relationships with people and attend to all needs without rushing.
· People were treated with kindness, respect and compassion; independence was encouraged where possible.
· Sufficient staffing levels with regular staff teams, travel time allocated between calls, and an on-call system in place.
Quality-Statement breakdown (16)
safe: Medicines managementRequires improvement
safe: Risk assessment and managementRequires improvement
safe: Staffing levels and recruitmentGood
safe: SafeguardingGood
effective: Staff trainingGood
effective: Supervision and appraisalRequires improvement
effective: Mental Capacity Act complianceGood
effective: Nutrition and hydration monitoringRequires improvement
caring: Dignity, respect and compassionGood
caring: Involvement in care and promotion of independenceGood
responsive: Care planning and reviewRequires improvement
responsive: End of life care planningRequires improvement
responsive: Complaints handlingGood
well-led: Governance and quality monitoring systemsRequires improvement
Home Instead Senior Care (Calderdale & Spen Valley) was rated Requires Improvement across all five key questions at its first inspection in June 2017, with two regulatory breaches identified relating to unsafe medicines management and failure to notify CQC of safeguarding incidents. Key concerns included missed calls, non-person-centred care plans, absent DNAR records, inconsistent dignity and communication, and insufficiently robust governance and quality monitoring systems.
Concerns (12)
criticalMedication management: “patch was recorded as administered twice...MAR had been repeated with different signatures of administration on both. Breach of Regulation 12 (g).”
criticalSafeguarding: “incidents relating to suspected emotional and financial abuse had not been notified to the CQC...breach of Regulation 18.”
moderateMissed or late visits: “Seven people we spoke with told us they had experienced missed calls...registered manager told us they didn't maintain a missed call log.”
moderateCare planning: “Care plans were not person centred and did not always contain the level of detail staff needed to make sure they delivered the care and support people needed.”
moderateRecord keeping: “one file we looked at did not contain any risk assessments in relation to the person being blind and hard of hearing.”
moderateEnd-of-life care: “care records for a person diagnosed with a terminal illness did not include a 'Do Not Attempt Resuscitation' (DNAR) order.”
moderateGovernance: “accidents and incident information was not collated and analysed to enable the registered manager to identify and address any emerging trends.”
moderateCommunication with families: “changes to the needs of people who used the service were not always communicated to staff...staff had turned up at people's houses when the office had been informed the person was in hospital.”
moderateIncident learning: “there was no analysis of complaints and concerns or call performance...MARs audits had failed to identify issues such as the ones described.”
minorInfection control: “they shove wet nappies and pads in the nearest bin even if it is overflowing...I have to tell them to wash their hands before doing my meals.”
minorConsent / capacity: “consent on one occasion had been sought from people's relatives even though the person had capacity to do this.”
minorComplaints handling: “I have made my views known but promises made to rectify the situation has not materialised.”
Strengths
· Staff received thorough induction including Care Certificate and training in safeguarding, MCA, moving and handling, medication and dementia care.
· Robust recruitment process including structured interviews, DBS checks, identity verification and reference checks.
· Regular supervision, annual appraisals and quarterly unannounced spot checks of care staff in people's homes.
· Electronic monitoring system to alert office when staff arrived and left a person's home.
· Care records written in a way which encouraged respectful, caring approaches and included detail about people's backgrounds and preferences.
Quality-Statement breakdown (20)
safe: Missed calls monitoringRequires improvement
safe: Medicines managementRequires improvement
safe: Safeguarding referrals and CQC notificationsRequires improvement
safe: Recruitment and staffing levelsGood
safe: Risk assessmentsRequires improvement
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Communication of care need changes to staffRequires improvement
Home Instead Senior Care (Calderdale & Spen Valley) achieved an overall rating of Good at this October 2019 inspection, having remediated two prior regulatory breaches relating to risk assessment, medicines management, and governance. The service was rated Requires Improvement for Responsive, primarily due to incomplete complaints closure confirmation and insufficient end-of-life care planning and staff training.
Concerns (4)
moderateComplaints handling: “the provider had not obtained confirmation from the complainant that they understood and were satisfied with the outcome of their complaint.”
moderateEnd-of-life care: “Training records showed less than a third of care staff had received training in providing end of life support.”
moderateCare planning: “Care files did not reflect a robust approach to gaining people's views about the care and support they would like to receive as they approached the end of their life.”
minorRecord keeping: “the list of medicines one person was taking had not been updated on this document.”
Strengths
· Risks to people's health and safety were identified with detailed risk management plans and control measures in place.
· Staff were recruited safely, well trained including specialist training (e.g. multiple sclerosis), and supported to achieve NVQs.
· People had consistent staff teams and felt safe; all spoke positively about staff being caring, kind and respectful.
· Electronic care plans with a live App allowed people and relatives to view care details and upcoming visits.
· Robust quality assurance systems including monthly accident audits, safeguarding analysis, and regular quality assurance home visits.
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Mental Capacity Act / consentGood
effective: Staff support: induction, training, skills and experienceGood
effective: Mental Capacity Act complianceGood
effective: DNAR recording in care plansRequires improvement
effective: Nutrition and hydration supportGood
caring: Staff approach and rapportRequires improvement
caring: Dignity and privacyRequires improvement
caring: Promotion of independenceGood
responsive: Person-centred care planning and involvementRequires improvement
responsive: Care plan reviews reflecting current needsRequires improvement