Cure Healthcare Services Limited received an overall rating of Requires Improvement (with Well-Led rated Inadequate) at this second consecutive inspection, with multiple regulatory breaches spanning medication records, recruitment, consent, staffing, complaints, and governance. A Warning Notice was issued for continued failure of good governance, and the provider's action plan from the previous inspection had not been implemented.
Concerns (15)
criticalMedication management — “Care staff hand wrote onto the MARs, they did not routinely include the name of the prescribed medicine, the dose, route or frequency.”
criticalStaffing levels — “Two don't always come and the one is on the phone trying to find a second person.”
criticalGovernance — “Quality assurance processes were ineffective in driving improvement. This was a continued breach of Regulation 17.”
criticalSupervision / appraisal — “One person had been employed since 2017, they had one recorded supervision meeting on file.”
criticalConsent / capacity — “The person had scored five out of 30 [MMSE], demonstrating severe memory loss. However, no capacity assessment had been completed.”
criticalComplaints handling — “Records relating to complaints were incomplete and did not demonstrate the complaint had been acknowledged or investigated.”
criticalSafeguarding — “The service had reported an alleged theft to the police. The service failed to inform us about this. One person had fallen resulting in a fractured hip.”
moderateRecord keeping — “Daily records written by care staff were of a poor quality. 'There's no detail about the person in the report it's just repeated sentences around the jobs they have done'.”
moderateStaff training — “No formal system was in place to ensure staff received training when required. Refresher training was overdue for several staff members.”
moderateCare planning — “Care plans did not provide adequate guidance for staff on how to support people with their medical conditions.”
moderateMissed or late visits — “We had to put [Name of person] to bed as they were due between 6:30pm and 7pm but nobody by 8:45pm so we did it.”
moderateLeadership — “The registered manager did not attend the office on a weekly basis. One member of staff told us the registered manager had been in the office twice a month.”
moderateIncident learning — “Accidents and incidents were not routinely analysed to look for themes and trends.”
moderateCultural competency — “'They [Care staff] talk so fast it's hard, it's a job to understand' and 'They do try and talk to mum, and they smile a lot, but English is a problem.'”
moderatePerson-centred care — “'I have an elaborate care plan, but they don't stick to it. I think it's written to get our business. It's never been reviewed.'”
Strengths
· Staff received training on safeguarding and were able to demonstrate their learning, including recognising and reporting abuse.
· Staff had access to personal protective equipment and people reported care workers left their property clean and tidy.
· The service carried out comprehensive pre-care risk assessments including medicine, home environment, falls, and moving and handling.
· The service made referrals to external healthcare professionals when required and reported concerns to the local authority.
· Some people reported consistently positive experiences with regular care workers, noting kindness and respect.
Quality-Statement breakdown (22)
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
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 requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersRequires improvement
Cure Healthcare Services Limited, a domiciliary care provider serving 7 people in Buckinghamshire and Slough, was rated Good across all five key questions at its February 2023 inspection. The service had successfully remediated all six regulatory breaches identified at its previous inspection in 2019, demonstrating significant and sustained improvement in governance, medicines management, recruitment, consent, care planning and complaints handling.
Strengths
· People felt safe from abuse and staff demonstrated good understanding of safeguarding procedures.
· Medicine administration records were completed accurately and staff competency was regularly assessed.
· Safe recruitment practices were in place including DBS checks and consistent staffing.
· Staff were appropriately inducted, trained, supervised every 3 months and appraised annually.
· Care plans were person-centred, comprehensive and developed collaboratively with people and relatives.
Quality-Statement breakdown (23)
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceGood
Cure Healthcare Services Limited was rated Requires Improvement overall following its first inspection in March 2018, with a regulatory breach under Regulation 17 for inadequate governance, incomplete records, and insecure handling of personal information. The service demonstrated genuine strengths in caring practice, safeguarding, and infection control, but required improvement in Mental Capacity Act compliance, staff supervision, end of life care recording, and quality assurance systems.
Concerns (7)
criticalGovernance — “Records relating to the management of the service were either partially completed or not completed at all and not fit for purpose.”
criticalRecord keeping — “When visiting the home of a person, we found personal information relating to another person who used the service, in the person's care plan.”
moderateSupervision / appraisal — “One staff member had a partially completed spot check whilst there were no records of spot checks in the other staff files we viewed.”
moderateConsent / capacity — “A person's care record stated they lacked capacity to make decisions... the person had signed to give consent for medicines to be administered.”
moderateCare planning — “People's needs and identified risks were reviewed... care documents did not support this. The registered manager acknowledged this.”
minorEnd-of-life care — “The question in regards to their end of life care wishes and preferences was left blank by staff. The person told us staff had not asked them questions.”
minorComplaints handling — “Out of the two homes visited we found only one person had the complaints procedure in their care records.”
Strengths
· People and relatives spoke positively about the caring nature of staff, with observed kindness, patience and dignity during home visits.
· Staff had a good understanding of safeguarding, with up-to-date policies and relevant training confirmed in staff files.
· Medicines were administered safely with staff competencies regularly assessed and an up-to-date medicines policy in place.
· Effective infection control practices observed, with staff using PPE appropriately during personal care tasks.
· The service matched staff to people based on language and cultural needs, and offered translators where required.
Quality-Statement breakdown (18)
safe: Recruitment practicesGood
safe: SafeguardingGood
safe: Medicines managementGood
safe: Infection controlGood
effective: Supervision and appraisalRequires improvement