Daisy Chain Care Team Ltd was rated Requires Improvement overall, with a breach of Regulation 17 (Good Governance) due to ineffective auditing, unassessed risks, incomplete recruitment checks and out-of-date care plans. Effective, caring and responsive remained Good, with positive feedback from people and relatives about kind, well-trained staff and a dedicated registered manager.
Concerns (11)
critical
Governance
: “the provider had not operated an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.”
criticalGovernance: “This was a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
moderateCare planning: “Risks to people's health were not always safely managed... these risks had not been assessed by the provider. These risks included for example choking and skin integrity risks.”
moderateCare planning: “A paper care plan had incorrect information relating to levels of food to administer, the amount recorded was much higher than the level recommended by the health professional.”
moderateMedication management: “Risks associated with people's medicines had not always been assessed... it was unclear what actions were taken as a result of spot checks when issues were found.”
moderateStaff competency: “staff competency checks were not taking place in relation to PEG care.”
moderateOther: “the provider had not obtained a full employment history for either of these new staff. This is an important check to ensure staff are safe to work in health and social care.”
moderateConsent / capacity: “staff we spoke with had varying levels of understanding of the MCA principles... the provider had not assured us there was a system in place for checking staff competencies around the MCA.”
moderateCare planning: “for both new business that had been referred to the service by health professionals and other new care packages no assessment had been completed.”
minorPerson-centred care: “information relating to people's likes and dislikes was very limited, and there was no information relating to people's life history.”
minorRecord keeping: “Policies and procedures at the service were generic. The complaints and compliments policy were not dated, neither was the IPC policy.”
Strengths
· People received their medicines as prescribed and on time, with errors quickly identified.
· People felt safe with staff; all staff had received safeguarding training.
· Effective infection prevention and control practices with consistent PPE use.
· Sufficient suitably qualified staff with regular induction, training and competency assessments.
· Staff spoke about people with kindness and compassion; people praised the caring approach.
Quality-Statement breakdown (25)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; supporting people to access healthcareNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot 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: Supporting people to develop and maintain relationships to avoid social isolationNot 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: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Continuous learning and improving careNot rated
well-led: Working in partnership with othersNot rated