Gevic Care Agency improved from Requires Improvement to Good across all five key questions, having remediated all prior regulatory breaches relating to risk management, medicines, infection control, recruitment, consent, and governance. A recommendation was made regarding the recording of telephone monitoring calls used to track staff attendance timekeeping.
Concerns (2)
minor
Record keeping
: “the registered manager made regular telephone calls to people to monitor staff timekeeping, however they did not record the outcome of these monitoring calls.”
minorGovernance: “minutes of the meetings were repetitive and did not indicate these were an open forum which allowed staff to share ideas and raise issues or concerns.”
Strengths
· All previous breaches of regulation (Regulations 12, 19, 11, 17) were resolved since the last inspection.
· Detailed care plans now in place covering risks, communication, nutrition, cultural/religious needs, and personal preferences.
· Safe recruitment procedures now followed including DBS checks, employment history, and right to work checks.
· Staff demonstrate good understanding of safeguarding and whistleblowing procedures.
· Communication passports developed to support people's communication needs in line with Accessible Information Standard.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
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 working with other agencies to provide consistent, effective, timely careGood
effective: Staff support: induction, training, skills, and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
caring: Respecting and promoting people's privacy, dignity, and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Ensuring people are well treated and supported; equality and diversityGood
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: 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, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
First inspection of this domiciliary care agency identified breaches of Regulations 11, 12, 17 and 19 covering consent, safe care, governance and recruitment, with a Warning Notice issued for good governance. Despite positive feedback about caring staff, widespread shortfalls in risk assessment, medicines, MCA compliance, infection control and quality assurance led to an overall Requires Improvement rating with Well-Led rated Inadequate.
Concerns (13)
criticalGovernance: “The provider did not have effective systems in place to monitor the safety and quality of the service as there were no formal audits or quality assurance checks.”
criticalMedication management: “one person's daily logs showed staff had administered their medicines on several occasions... 'Yes, I only give them when the family member is too busy.'”
criticalCare planning: “The risk of skin breakdown had not been recorded in the care plan and there were no instructions in place to ensure staff knew how to mitigate the risks.”
criticalConsent / capacity: “Mental capacity assessments were not carried out when the provider had cause to suspect people did not have capacity to consent to their care.”
criticalInfection control: “Staff were not carrying out twice weekly COVID-19 tests according to current government guidelines.”
criticalOther: “References obtained prior to employment did not provide satisfactory evidence of conduct in, or reason for leaving, previous roles working with children or vulnerable adults.”
criticalLeadership: “The registered manager had been unwell and unable to attend work for several weeks; however, they had not made suitable arrangements for the management of the service in their absence.”
moderateStaff competency: “Staff received training in the administration of medicines, however, their competency had not been assessed in line with best practice guidance.”
moderatePerson-centred care: “One person's care plan stated they 'can become vicious' during personal care. There was no information in the care plan about what staff could do to alleviate the person's anxiety and distress”
moderateCommunication with families: “People's communication needs were not assessed, and care plans contained insufficient information about people's communication preferences.”
moderateEnd-of-life care: “People had not been consulted about whether they had any end of life preferences.”
moderateCultural competency: “Care plans did not contain any information about people's cultural or religious needs or protected characteristics.”
moderateRecord keeping: “Care plans did not contain information on the model or maintenance history of moving and handling equipment being used to ensure it was safe to use.”
Strengths
· People and relatives were positive about the caring nature of staff and being treated with dignity and respect
· Staff received induction, training, regular supervision and felt supported by the registered manager
· Staff had a good understanding of safeguarding and whistleblowing procedures
· Care visits were delivered on time with sufficient staffing and regular care workers
· Staff had access to and used appropriate PPE during care delivery
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Learning lessons when things go wrongNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards
Not rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Staff support: induction, training, skills, and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
caring: Respecting and promoting people's privacy, dignity, and independenceNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Ensuring people are well treated and supported; equality and diversityNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Working in partnership with othersNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Duty of candourNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated