Cynosure Health Care Ltd was rated Requires Improvement overall following a focused inspection of Safe and Well-led, with breaches of Regulation 12 (safe medicines management) and Regulation 17 (good governance) identified. While staff were praised for their caring, person-centred approach and communication, medication administration records were incomplete and auditing systems failed to identify or drive improvements in compliance.
Concerns (8)
criticalMedication management: “People's medicine administration records did not always record the dosage or the name of the medicine prescribed.”
criticalMedication management: “A person's care records instructed staff to administer medicine from a dosset box prepared by a family member and not by a pharmacist.”
criticalGovernance: “Audits had failed to identify medication administration records, and medication administration, were not being carried out in line with the provider's policy.”
moderateGovernance: “Audits did not record what action was to be taken, by whom and when and subsequent audits showed improvements were not consistently achieved.”
moderateStaff competency: “We could not be confident in the competency assessments of staff given they were not consistently following the provider's policy or procedure for medicines.”
moderateConsent / capacity: “The best interest decision was not supported by a clear and agreed protocol of care for staff to follow.”
moderateRecord keeping: “The topic such as 'notes audit' and 'medication records' was followed by a tick or yes, with no information as to what evidence had been used to assess quality.”
minorSafeguarding: “Not all staff were aware of external organisations they could refer safeguarding concerns to. For example, the local authority safeguarding team.”
Strengths
· Family members spoke positively about staff being kind, caring, and having a positive impact on relatives' day-to-day lives.
· Staff demonstrated cultural competency, including learning to prepare culturally appropriate meals such as Jamaican food.
· Risk assessments were in place with clear guidance for staff, including catheter care and moving and handling.
· Sufficient staffing levels with consistent staff allocation, promoting continuity of care.
· Safe recruitment practices including DBS checks and structured induction.
Quality-Statement breakdown (9)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
safe:Insufficient evidence to rateeffective:Insufficient evidence to ratecaring:Insufficient evidence to rateresponsive:Insufficient evidence to ratewell-led:Insufficient evidence to rate
Cynosure Health Care Ltd was inspected on 3 November 2017 as a newly established homecare agency providing personal care to a single person, staffed only by a husband-and-wife team including the registered manager. Insufficient evidence was available across all five key questions to award a rating, though no concerns were raised and foundational systems were found to be in place.
Strengths
· Appropriate recruitment procedures including DBS checks and personal references were in place
· Risk assessments positively promoted independence and identified support required
· Registered manager was knowledgeable, approachable and motivated about service development
· Quality monitoring systems including questionnaires and audit forms were in place
· Induction and ongoing training arrangements were established for future staff
Quality-Statement breakdown (5)
safe: SafeInsufficient evidence to rate
effective: EffectiveInsufficient evidence to rate
caring: CaringInsufficient evidence to rate
responsive: ResponsiveInsufficient evidence to rate
Cynosure Health Care Ltd was rated overall Good at its January 2019 inspection, with safe, effective, caring and responsive domains all rated Good. Well-led was rated Requires Improvement due to governance systems failing to identify that mental capacity assessments were not decision-specific and that easy-read complaint documents were absent, though the provider addressed both issues before the inspection concluded.
Concerns (3)
moderateGovernance: “The systems that were in place had not identified that mental capacity assessments were not decision specific and that best interest meetings had not been held.”
moderateConsent / capacity: “not all MCA's were decision specific. The provider met with people and their families [where appropriate] and updated the MCA's and best interest assessments before the inspection was concluded.”
minorSupervision / appraisal: “Staff had not yet had an appraisal of their performance but plans were in place to complete these.”
Strengths
· People felt safe and staff were knowledgeable about safeguarding procedures
· Individualised risk assessments were in place and clear to staff
· Sufficient staffing levels with on-call cover for emergencies
· All staff held an NVQ and received ongoing refresher training
· Care plans were personalised, detailed and co-produced with people and relatives