Triple Care Healthcare Services received an overall rating of Requires Improvement following its first inspection, with three regulatory breaches identified relating to consent and MCA compliance (Regulation 11), safe care and medicines management (Regulation 12), and governance and record-keeping (Regulation 17). Caring and responsive practice were rated Good, with people and relatives speaking positively about staff kindness, consistency, and responsiveness to their needs.
Concerns (6)
criticalCare planning: “Where specific health conditions meant people may be at risk of ill health guidance was not always in place to inform staff of the signs they should look for, action to take”
criticalMedication management: “Staff supported a number of people by preparing their medicines and leaving them out for them to take later... We found no risk assessments or guidance for staff had been completed.”
criticalConsent / capacity: “The provider was unable to demonstrate their understanding of the MCA processes... only one staff member had completed MCA training.”
criticalGovernance: “There was no system in place for ensuring that care records were regularly checked and updated... structured audit systems were not in place.”
criticalSafeguarding: “External doors were locked preventing the person leaving and the persons telephone was removed at night... no capacity assessment or best interest decision had been completed.”
moderateRecord keeping: “Other people's care records contained contradictory information which meant people may be at risk of not receiving the right care.”
Strengths
· Sufficient numbers of skilled and experienced staff were employed and people told us staff arrived on time and stayed for the duration of the call.
· Safe recruitment practices were followed including DBS checks, references and face-to-face interviews.
· Staff received regular supervision, induction and training including the Care Certificate.
· People were treated with dignity and respect and their independence was supported.
· Personalised care plans were in place and people received care from a consistent staff team.
Triple Care Healthcare Services improved from Requires Improvement to Good across all five key questions, having remediated prior breaches of Regulations 11, 12 and 17. The sole area for development was insufficient detail in end-of-life care plans regarding people's religious and faith-based needs.
Concerns (1)
minorEnd-of-life care: “One area that could improve was the level of detail to guide staff on meeting religious or cultural needs...the information on what staff could and could not do regarding the persons faith was limited.”
Strengths
· Risk assessments were comprehensive and gave clear guidance to staff on supporting people safely, including mobility, falls, skin conditions and medicines.
· Medicines were managed safely using electronic records; only trained and competency-checked staff administered medicines.
· People felt safe with staff and safeguarding procedures followed local authority best practice guidance.
· Sufficient staffing levels with continuity of care; people reported staff arrived on time and never missed calls.
· Staff received mandatory training, annual appraisal and regular supervision to maintain skills and best practice.
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills 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: End of life care and supportGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood