Date of Assessment: 15 October to 23 October 2024. The service is a domiciliary care agency. It provides personal care to people living in their own homes. They supported adults of all ages, including people with physical disabilities and those living with dementia. At the time of the inspection 70 people were receiving support with personal care. The service had made improvements since the last inspection and is no longer in breach of regulations. Monitoring and quality assurance systems had been improved to ensure it was more effective in identifying areas for improvement and improving people’s care. Care plans had been updated to include more detailed guidance for staff to help keep people safe and understand their needs. The service had a good learning culture and people and staff could raise concerns. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular supervision to support them in their role. People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Staff worked with all agencies involved in people’s care for the best outcomes. They monitored people’s health to support healthy living and responded appropriately if their health conditions changed. People were treated with kindness and compassion and were always involved in decisions about their care. Staff treated people as individuals and supported their preferences. People knew how to give feedback and were confident the service took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally.
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Temp Exchange Ltd was rated Requires Improvement overall, with Safe rated Inadequate due to breaches in safeguarding, safe care and treatment (including a serious medicines error), and good governance. Despite caring staff and compliant recruitment and MCA practice, risk assessments, person-centred care planning, complaints follow-through and quality monitoring were not effective.
Concerns (10)
criticalSafeguarding: “people were not always protected from abuse because the provider failed to identify when abuse had taken place”
criticalMedication management: “we found major concerns in relation to one person who had been administered medicine not prescribed for them for a week without the provider noticing.”
criticalGovernance: “Governance arrangements had not operated effectively to improve the quality and safety of the service.”
moderateCare planning: “risk assessments were unclear and did not provide guidance on how some risks should be managed.”
moderateIncident learning: “records of incidents reviewed did not demonstrate the outcomes and where there had been learning from them.”
moderatePerson-centred care: “Care plans provided details of people's needs, however they were not always person-centred.”
moderateComplaints handling: “the provider was aware that aspects of the procedure were not always followed, such as informing people of the outcome of their complaint in writing.”
moderateMissed or late visits: “Some of the concerns identified included missed visits.”
moderateRecord keeping: “they had failed to identify that the care records were not accurate, risk assessments were not detailed and care plans were not person centred.”
minorStaff competency: “I don't think she has been trained to deal with mental health issues... she just doesn't have the background for dealing with mental health.”
Strengths
· Staff treated people with dignity and respect and encouraged independence
· Staff received induction based on the Care Certificate and training in mandatory and specialist areas
· Recruitment practices included criminal record checks and right-to-work checks
· Service worked within the principles of the Mental Capacity Act and obtained consent
· Staff used appropriate PPE and followed infection control practices
Quality-Statement breakdown (5)
safe: Is the service safe?Inadequate
effective: Is the service effective?Requires improvement
caring: Is the service caring?Good
responsive: Is the service responsive?Requires improvement
well-led: Is the service well-led?Requires improvement