Night and Day Care received an overall rating of Requires Improvement, with four regulatory breaches identified covering safe care and treatment, person-centred care, good governance, and staffing. While relatives praised the kindness and consistency of care workers, significant failings were found in medicines management, risk assessment, staff training currency, incident learning, and quality assurance processes.
Concerns (12)
criticalMedication management: “Where people had been prescribed medicines which were to be administered as and when required (PRN), there was no information provided for staff to indicate when these should be given.”
criticalCare planning: “People's care plans provided a list of the care tasks required during each visit but there was limited information on how the person wanted their care provided.”
criticalStaff training: “Certificates showed that staff had last completed training including moving and handling, safeguarding, infection control between 2017 and 2020, which indicated staff did not have up to date training.”
criticalIncident learning: “We reviewed the record of an incident and accident which had occurred...lessons had not been identified and care plans and risk assessments were not updated.”
criticalGovernance: “The provider did not have a quality assurance process to enable them to identify if actions were required to make improvement to the care provided.”
criticalSafeguarding: “We saw a safeguarding concern had been raised with the local authority but there were only copies of emails...no review of the possible actions which could be taken to mitigate risks.”
moderateEnd-of-life care: “People's end of life care wishes were not identified as part of their care plan...the care plans did not include any information on how the person wanted this care provided.”
moderateComplaints handling: “A complaint had been received...there was no analysis of the issues of the complaint to enable the provider to identify what they needed to introduce to reduce the same issues happening again.”
moderatePerson-centred care: “1 person's care plan stated they should be supported with 'a wash' but did not explain how this should be provided to reflect the person's preferences for their care.”
moderateRecord keeping: “The registered manager confirmed they did not carry out formalised quality assurance checks in relation to care plans, the administration of medicines, staff training and the records of care.”
moderateLeadership: “The registered manager was not aware of the regulatory requirements to send notifications to the Care Quality Commission.”
minorCultural competency: “People's care plans did not identify their religious and cultural preferences.”
Strengths
· Safe recruitment process in place with 2 references, right-to-work checks, and DBS checks for all staff.
· Staff had access to PPE and relatives confirmed it was worn correctly during care visits.
· Relatives reported staff were kind, caring and respected people's dignity and privacy.
· Consistent staffing ensured the same care workers visited people, supporting familiarity and continuity.
· People were supported to maintain independence, relationships and preferred activities.
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrong; safeguardingRequires improvement
safe: Preventing and controlling infectionGood
safe: Staffing and recruitmentGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control; end of life careRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to maintain relationships and take part in activitiesGood
well-led: Continuous learning and improving care; governance, duty of candour and regulatory complianceRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Working in partnership with othersRequires improvement