Umbrella Care (Midlands) Ltd was rated Requires Improvement overall at its first ratings inspection in January 2018, with four regulatory breaches identified covering consent/MCA, staffing/training, governance, and registration notifications. Caring and responsive practice was Good, with staff praised for compassion and consistency, but significant gaps in auditing, record keeping, MCA compliance, and staff training competency assessment posed risks to safe and effective care.
Concerns (9)
criticalConsent / capacity: “there were no mental capacity assessments in place for people...we could not be assured that the provider was working in line with the principles of the MCA 2005”
criticalStaff training: “not all staff had received training in safeguarding and the MCA. Staff we spoke with had varying knowledge in safeguarding and poor knowledge of the MCA”
criticalGovernance: “there were no specific audits in place to check that people were receiving the care required...no medication audits, audits on care files or other areas of care”
moderateMedication management: “there were no details in the records of the medicines and how often these needed to be prompted...no medicine records to give staff guidance on how much of their medicine was needed”
moderateStaff competency: “there were no systems in place to ensure that staff had understood the training provided...the registered manager and provider were unaware that staff had varying knowledge”
moderateRecord keeping: “records did not always contain an accurate reflection and reviews of people's care had not been recorded where changes had been made”
moderateSupervision / appraisal: “staff had not always received a supervision...other staff had not yet received a supervision to discuss their role and any development needs”
moderateCare planning: “people's risk assessments did not always contain sufficient details and there was a potential risk that new staff would not have the information required to support people safely”
minorCultural competency: “the assessment form did not detail specific information about people's diverse needs such as cultural background, religion or their sexuality”
Strengths
· Staff were caring, compassionate and showed patience; people and relatives praised staff highly
· Sufficient staffing levels maintained with consistent staff groups assigned to people
· People arrived on time with no missed calls reported by relatives
· Infection control measures in place with PPE consistently used by staff
· People's dignity, privacy and independence were respected and promoted
Umbrella Care (Midlands) Ltd improved from Requires Improvement to Good across all five key questions, having resolved previous regulatory breaches in consent, staff training, registration and governance. Minor gaps remained around routine end-of-life care planning and recording of people's sexuality, both of which the provider committed to address.
Concerns (2)
minorEnd-of-life care: “conversations with people about end of life care were not routinely undertaken. They were only in place when people were nearing end of life.”
minorPerson-centred care: “people were not asked about their sexuality, following our feedback, the provider had plans to ensure this would be implemented and recorded during people's admission stage.”
Strengths
· Provider made considerable improvements since previous Requires Improvement rating, resolving all prior regulatory breaches including consent, staff training, registration and governance.
· People felt safe and reported positive experiences; relatives confirmed staff were always on time and knew people well.
· Personalised care planning with lead carers assigned to individuals, ensuring consistent and responsive support.
· Strong multi-agency working with GPs, district nurses, occupational therapists and other professionals to achieve positive outcomes.
· Effective quality monitoring systems with prompt action taken when audits identified improvement areas.
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standardsGood
effective: Staff skills, knowledge and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood