Ethical Homecare Solutions achieved a Good rating across all five key questions at this February 2018 inspection, having successfully remediated a previous breach of Regulation 12 relating to medicines management. The service demonstrated strong person-centred care, robust governance, a culture of continuous improvement, and highly motivated staff committed to dignity and respect.
Concerns (1)
critical
Medication management
: “At the last inspection we found there was a breach of Regulation 12...people were not protected against the risks associated with medicines because the provider did not always have appropriate arrangements in place to manage medicines.”
Strengths
· People's medicines were managed and administered safely following improvement from previous inspection breach, with MAR records completed appropriately and competency checks in place.
· Staff were safely recruited with appropriate DBS checks, references and ID verification.
· People felt safe and praised staff warmth, with one person stating 'The whole experience has been first class, I couldn't have wished for a better team of people to care for me.'
· Staff received regular supervision every six to eight weeks, with spot checks and issues addressed through individual supervision.
· Care plans were personalised, regularly reviewed, and developed with involvement of people and their families.
Ethical Homecare Solutions was rated Requires Improvement overall following a June 2015 inspection, with two regulatory breaches identified: failure to report safeguarding incidents to the local authority and CQC (Regulation 13), and absence of decision-specific mental capacity assessments (Regulation 11). The service was well-led with a highly regarded registered manager and effective quality assurance systems, but required improvements in care planning, staff MCA competency, supervision consistency, and call-time reliability.
Concerns (9)
criticalSafeguarding: “some concerns raised had been addressed as complaints and conduct issues and had not been recognised as safeguarding matters. The registered manager had not reported these incidents to the local authority or to CQC”
criticalConsent / capacity: “care and support plans did not include an assessment of people's mental capacity to make decisions...This was a breach of Regulation 11, Need for consent”
moderateCare planning: “One person who had diagnosis of dementia had nothing in the care plan about the ways in which they communicated...Another care plan had not been updated when the person's circumstances changed.”
moderateRecord keeping: “care plans for people who used the service did not all have an up to date list of medication that people took”
moderatePerson-centred care: “Records we looked at did not show how people who used the service were involved in identifying their care preferences...None of the care records we looked at had been signed by people who used the service”
moderateMissed or late visits: “some people said the call times were not adhered to as the majority of staff relied on public transport which meant they were frequently late and then rushed”
moderateSupervision / appraisal: “some staff had received one to one supervision on a monthly basis, some on a quarterly basis and others who had not received a documented one to one supervision for over six months”
moderateStaff competency: “despite having received training, staff had a limited understanding of the MCA and how this affected their work...another staff member asked what the MCA was”
minorGovernance: “The registered manager said they also checked daily notes to monitor call times and duration of calls, this was not fully documented either.”
Strengths
· Staff demonstrated good knowledge of safeguarding and could identify types of abuse; training records confirmed this.
· Medication administration records were completed correctly and registered manager checked all MAR records on return to office.
· Robust complaints handling process with written responses and evidence of learning shared with staff via memos.
· People and relatives spoke highly of the registered manager, describing them as approachable and responsive.
· Regular spot checks (25 carried out in-year) with action plans and follow-up to drive continuous improvement.
Quality-Statement breakdown (15)
safe: Safeguarding incidents not reported to local authority or CQC — breach of Regulation 13Requires improvement
safe: Two recently recruited staff commenced work without completed DBS checksRequires improvement
safe: Medication administration records completed correctly; competency spot-checkedGood
safe: Mixed views on call time adherence; some staff frequently late due to public transportRequires improvement
effective: Mental capacity assessments not completed — breach of Regulation 11Requires improvement
effective: Staff had limited working knowledge of the Mental Capacity Act despite trainingRequires improvement
effective: Induction training comprehensive; rolling refresher programme in placeGood
Ethical Homecare Solutions was rated Requires Improvement overall following an announced inspection in November 2016, with a breach of Regulation 12 identified due to unsafe and inconsistent medicines administration practices, including inadequate MAR completion, conflicting staff instructions, and ineffective medication audits. The service performed well in effective, caring and responsive domains, demonstrating strong person-centred care, good staffing practices and improvements in safeguarding since the previous inspection.
Concerns (7)
criticalMedication management: “We found the systems in place to manage and monitor people's medication were not robust and there was a risk people may not receive their medication as prescribed.”
criticalMedication management: “The MAR charts did not list the medication prescribed, when they must be given, what the dose was or any special instructions.”
criticalMedication management: “We saw there had been seven medication incidents or errors in the last six months. On some occasions medical advice was not always sought.”
criticalMedication management: “Staff we spoke with were given inconsistent responses... One staff member said they followed instructions written on a notice board in a person's home.”
moderateGovernance: “The medication audits we looked at were not effective and had not identified the concerns we found at this inspection.”
minorIncident learning: “The registered manager monitored any accidents or incidents... however, there was no documentary analysis of incidents to identify any patterns or trends.”
minorComplaints handling: “The registered manager did not have a system in place to carry out an analysis of complaints to look at any emerging themes.”
Strengths
· Staff could recognise abuse and knew what action to take; safeguarding improvements made since last inspection in June 2015.
· Sufficient staffing levels with consistent, familiar carers; 100% of staff confirmed adequate time to complete care plan requirements.
· Robust recruitment procedures including DBS checks followed for all new staff.
· Staff received thorough induction including Care Certificate, shadow shifts, regular supervision, appraisal and spot checks.
· Person-centred, detailed care plans regularly reviewed and updated; people and relatives involved in care planning.
Quality-Statement breakdown (16)
safe: Medicines administration and managementRequires improvement
safe: Safeguarding people from abuseGood
safe: Staffing levels and consistencyGood
safe: Safe recruitment practicesGood
safe: Risk assessment and managementGood
effective: Staff training, induction and developmentGood
effective: Mental Capacity Act compliance and consentGood
effective: Nutrition, hydration and health supportGood
effective: Supervision frequency inconsistent; some staff without documented supervision for over six months
Requires improvement
caring: Staff knew people's likes and dislikes and maintained good relationshipsGood
caring: Some staff talked over service users in their own language; rushed care reportedRequires improvement
responsive: Care plans lacked detail, not always updated, and involvement of people not documentedRequires improvement
responsive: Complaints system effective; concerns investigated and responded to in writingGood
well-led: Registered manager approachable and highly regarded by staff and people using the serviceGood
well-led: Quality assurance systems in place including spot checks, questionnaires and management meetingsGood
well-led: Monitoring of MAR records and call times not fully documentedRequires improvement
caring: Dignity, respect and person-centred approachGood
caring: Promoting independenceGood
caring: Involvement of people and relatives in careGood
responsive: Person-centred care planningGood
responsive: Complaints handling and responsivenessGood
well-led: Medicines governance and auditRequires improvement
well-led: Quality assurance and oversight systemsRequires improvement