ReadyCQC, a weekly field guide to CQC home-care regulation

Inspection report · 2021-11-24

Framework: KLOE · 14 pages · 85 KB · PDF

Requires improvement

safe: Requires improvementeffective: Requires improvementcaring: Goodresponsive: Requires improvementwell-led: Requires improvement

Caremark - Charnwood, a domiciliary care agency supporting 60 people, was rated Requires Improvement overall at this May 2020 inspection, with a breach of Regulation 12 due to unsafe medication administration and inadequate personalised risk assessments. While staff were caring and recruitment was safe, persistent governance failures, poor care plan personalisation, and incomplete quality assurance systems remained unresolved from the previous inspection.

Concerns (12)

criticalMedication management: “Medicines were not managed safely as staff did not sign to say individual medication had been administered.”
criticalMedication management: “Staff did not record why PRN ('as required') medicines were administered.”
moderateCare planning: “Generic risk assessments were in place however they were not person centred.”
moderateRecord keeping: “Where people had a Lasting Power of Attorney appropriate records were not always completed.”
moderateRecord keeping: “The manager confirmed referrals were being made to the GP...however, they were unable to evidence due to lack of recording on internal electronic systems.”
moderateGovernance: “Quality assurance systems were not adequately in place to assess, monitor and improve the quality and safety of the service provided.”
moderateGovernance: “The manager undertook quality audits...however, these audits did not always highlight gaps.”
moderateMissed or late visits: “An example of this was people experienced missed calls. To mitigate this risk an electronic call monitoring app was in the process of being introduced.”
minorCare planning: “Care plans did not record people's likes and dislikes in terms of nutrition adequately.”
minorComplaints handling: “At the time of our inspection the provider did not have a system in place to identify themes and trends.”
minorEnd-of-life care: “The service had an end of life policy in place. However, care plans we looked at did not contain end of life wishes.”
minorPerson-centred care: “Care plans needed more personalisation. For example, they did not include information such as peoples likes and dislikes.”

Strengths

· People felt safe and well cared for, with relatives confirming staff were kind, caring and attentive to people's needs.
· Safe staff recruitment processes were in place with appropriate criminal and reference checks.
· Sufficient numbers of staff were employed to meet people's needs at the time of inspection.
· Staff understood their safeguarding responsibilities and had received safeguarding training.
· Staff received the training and support required for their role, with a training matrix in place.

Quality-Statement breakdown (23)

safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
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: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement

Inspection report · 2021-10-30

Framework: KLOE · 14 pages · 80 KB · PDF

Requires improvement

safe: Requires improvementeffective: Goodcaring: Goodresponsive: Goodwell-led: Requires improvement

Caremark Charnwood was rated Requires Improvement overall at this January 2019 inspection, having declined from Good in 2016, with principal concerns around failure to follow safeguarding processes promptly, generic risk assessments, a missed care call, occasional staffing shortfalls, and audit systems that did not detect documentation gaps. Effective, caring and responsive domains were rated Good, reflecting competent and kind staff, robust care planning involvement, and appropriate complaints handling.

Concerns (8)

criticalSafeguarding: “the provider's safeguarding processes had not been followed and an allegation of concern had not been followed up in a timely manner... no immediate action had been taken to report the concern to the safeguarding team”
moderateCare planning: “not all the assessments seen included person specific information and were more generic in nature... one person's plan of care stated they should not be left with any hot drinks or anything sharp, this risk had not been identified”
moderateGovernance: “Whilst systems were in place to monitor the quality and safety of the service, these had not identified omissions within some people's documentation.”
moderateMissed or late visits: “one member of staff said a person they had visited that morning, had not received their call the previous morning... they had missed a morning call and therefore not prompted to take their medicines”
moderateStaffing levels: “one member of staff informed us they had been allocated to support a person on their own: the person had been assessed as requiring two staff members.”
minorRecord keeping: “People's plans of care had not always been signed by the person or by the person's representative... neither the initial assessment or plan of care had been signed”
minorConsent / capacity: “Not all of the staff we spoke with could remember completing training in MCA but those that did, understood its principles.”
minorMedication management: “a recent audit had identified staff had not always signed the charts when they administered people's medicines.”

Strengths

· Staff were kind, caring and treated people with dignity and respect, with people consistently reporting feeling safe and well supported.
· Appropriate pre-employment checks including DBS and references were carried out for all new staff.
· Staff received induction, Care Certificate support, shadowing, spot checks, supervisions and annual appraisals.
· People were supported to maintain good health with staff monitoring wellbeing daily and escalating concerns to healthcare professionals.
· A formal complaints process was in place and complaints were handled appropriately and in line with policy.

Quality-Statement breakdown (15)

safe: Risk assessments not always personalised or reflecting current needsRequires improvement
safe: Safeguarding processes not consistently followed by managementRequires improvement
safe: Missed call resulting in missed medicines promptRequires improvement
safe: Staffing levels not always sufficient to meet assessed needsRequires improvement
safe: Recruitment checks, infection control and medicines management processes in placeGood
effective: Staff trained and competent; induction and Care Certificate completedGood
effective: MCA training not recalled by all staff; recommendation madeGood
effective: People supported with nutrition, health monitoring and healthcare access

Inspection reports (4)