Authentic Kare Milton Keynes improved from Requires Improvement to Good following a focused inspection of Safe and Well-Led, having successfully addressed previous breaches of Regulations 17 and 19. The service demonstrated embedded improvements in recruitment, governance, risk management and medicines safety, with relatives and staff reporting high levels of satisfaction.
Concerns (3)
minorRecord keeping: “The registered manager had not submitted their annual Provider Information Return (PIR) to CQC.”
minorSupervision / appraisal: “Surveys had not been completed recently by staff. The registered manager explained there was recent discussion with staff about different formats of gathering feedback.”
minor
Incident learning
: “The provider informed us they would re-introduce a monthly analysis of accidents and incidents to strengthen the systems in place.”
Strengths
· Safe recruitment processes embedded following previous breach of Regulation 19, with DBS and overseas police checks completed.
· Comprehensive quality assurance audits with action plans embedded into practice, resolving previous breach of Regulation 17.
· People received consistent care from regular staff who knew them well; relatives reported high satisfaction.
· Staff supported through supervision, spot checks, competency checks and monthly team meetings.
· Medicines administered safely with MAR records, PRN guidance, staff competency assessments and medicines audits.
Authentic Kare Milton Keynes was rated Requires Improvement following a focused inspection that identified two regulatory breaches in safe recruitment (Reg 19) and good governance (Reg 17). While people reported positive experiences of care, timeliness and safety, recruitment checks, records management, medicines guidance, risk reviews and quality oversight all required strengthening.
Concerns (9)
criticalStaff competency: “Safe recruitment processes were not always followed. For example, there were gaps in employment histories and not all employees had suitable references.”
criticalGovernance: “The provider failed to ensure robust systems and processes were in place to manage the service effectively. Systems and processes in place to assess, monitor and improve the service were not effective”
moderateStaffing levels: “The staff rota we looked at included staff scheduled to work up to 18 calls in a day starting at 6.15am and finishing at 9.10pm.”
moderateRecord keeping: “Records management was disorganised and chaotic. For example, we found multiple systems in use, including an electronic system used by care staff to update tasks, word documents on the computer for care plans”
moderateCare planning: “some people were at higher risk of pressure wounds or expressing distressed behaviour but the care plans in the office had not been updated in over twelve months.”
moderateMedication management: “Guidance for staff to follow when medicine was administered 'as needed' was not held on the electronic system. For example, what circumstances the medicine should be given or the maximum dose”
moderateIncident learning: “Regular reviews of accidents and incidents to identify any patterns or themes and identify where lessons could be learned did not take place. This meant opportunities for improvement may be missed.”
moderateLeadership: “The provider was not prepared or organised to facilitate a CQC inspection. We could not gain access to the office on the first day of the inspection, and on the second day limited information was available”
minorSupervision / appraisal: “There was no overall tracker to show when these took place, so the provider could not confirm these occurred at the frequency set out in their policy”
Strengths
· People and relatives provided positive feedback about the quality, timeliness and consistency of care received
· People felt safe with the care they received and safeguarding processes were followed when required
· Staff had received training in infection prevention and control with positive feedback about staff practice
· Staff always had access to PPE including masks, aprons, gloves and hand sanitiser
· Person-centred care delivered with families involved and accommodating call time changes
Quality-Statement breakdown (9)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; engaging and involving people, public and staff