Choice Global (Drama Room) was rated Requires Improvement across all five key questions, with breaches of Regulations 9, 11, 12, 17 and 19 identified, representing a failure to improve since the previous 2019 inspection. Key failures included unsafe medicines management, absent or non-personalised care plans and risk assessments, gaps in staff training and recruitment, and ineffective governance systems.
Concerns (14)
criticalMedication management — “Medicines were not being managed safely. In some people's risk assessments, there was no information on the types of medicines people were using, how to store it or the possible side effects.”
criticalCare planning — “5 people did not have detailed care plans in place which meant it was hard to find information on how people wished their care to be delivered.”
criticalPerson-centred care — “There was no information recorded on people's likes and dislikes, how they liked their personal care to be delivered, oral hygiene, people's backgrounds, hobbies or interests.”
criticalConsent / capacity — “The provider had not completed capacity assessments for people whose capacity to consent was in doubt.”
criticalGovernance — “The provider did not have effective quality assurance systems in place to monitor, manage and improve service delivery.”
moderateStaff training — “It was mandatory for the provider to provide training for staff in learning disability and autism. The Nominated Individual was not aware that this training was required.”
moderateSupervision / appraisal — “We identified gaps in staff supervisions as no staff were consistently receiving supervision in line with the providers policy.”
moderateStaffing levels — “People who required 2 carers not always having this.”
moderateMissed or late visits — “Our analysis highlighted timekeeping issues, including examples where care workers were not logging calls correctly.”
moderateSafeguarding — “They were not always following their policy as they did not notify the CQC of a recent safeguarding concern.”
moderateRecord keeping — “Accurate, complete and contemporaneous care records were not always maintained... the registered manager was not aware that staff were not recording or completing information correctly.”
moderateIncident learning — “The registered manager was not always analysing themes and trends to prevent reoccurrences.”
minorCultural competency — “People's diverse needs, including religion, culture and language, were not assessed as part of the care planning process.”
minorCommunication with families — “People using the service and their relatives were not always involved in developing their care. Care plans were not stored in people's houses.”
Strengths
· People told us they felt safe and staff understood how to safeguard people from the risk of abuse
· Staff used personal protective equipment and had good hand hygiene practice; infection control training was completed
· Relatives confirmed people were supported to access healthcare professionals including GPs, district nurses, occupational therapy and physiotherapy
· People spoke positively about care staff being kind, caring and respectful of dignity and privacy
· The provider worked in partnership with a variety of agencies such as district nurses, podiatrists and social care professionals
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staff; Promoting a positive cultureRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
Choice Global received an overall rating of Requires Improvement at its first CQC inspection, with safe and well-led domains falling short due to insufficiently detailed risk assessments, incomplete recruitment checks, and absent formal auditing processes. The service performed well in effective, caring and responsive domains, with staff praised for punctuality, kindness and person-centred practice.
Concerns (5)
moderateCare planning — “risk assessments did not give the detailed guidance in how to mitigate risks in areas such as moving and handling and other identified risks to people's well-being.”
moderateRecord keeping — “staff application forms lacked the appropriate dates of previous employment required to allow the provider to check any gaps in their work history.”
moderateGovernance — “Audits were not completed to ensure the quality of the service...the registered manager told us due to being so 'hands on' they had not completed the required audits.”
moderateCare planning — “Care plans listed the support required but lacked the guidance for staff on how to deliver the support as the person wanted.”
minorGovernance — “call logs were not audited to ensure late calls were looked at.”
Strengths
· Staff demonstrated good safeguarding knowledge and knew how to escalate concerns to the local authority and CQC.
· Medicines were managed safely with monthly reviews of administration records by the registered manager.
· Calls were delivered on time and relatives confirmed staff were punctual or communicated delays.
· Care plans were person-centred, reflecting people's preferences, cultural and religious beliefs.
· Staff received regular training, induction, shadowing, supervisions and competency assessments.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
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 lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff worked with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Personalised careGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Service management and governanceRequires improvement
well-led: Continuous learning and improving careGood
well-led: Planning and promoting person-centred, high-quality care and duty of candourGood
well-led: Managers and staff being clear about their roles and understanding quality performanceGood