First inspection of a small domiciliary care service rated Requires Improvement overall, with a breach of Regulation 19 due to missing DBS and reference checks for newly recruited staff. Caring and responsive aspects were rated Good, but governance, MCA capacity assessments and recruitment oversight needed improvement.
Concerns (7)
critical
Staff competency
: “For one person that had been in employment for four weeks, no criminal records check to the Disclosure and Barring Service (DBS) had been requested.”
criticalStaff competency: “The other member of staff did not have reference checks in place.”
moderateConsent / capacity: “We found capacity assessments needed clarity to demonstrate how a person's capacity had been assessed; and to ensure a person's mental capacity was assessed independent of their mental health.”
moderateStaff training: “The registered manager and one staff member had received training in the MCA. However, further training was needed.”
moderateGovernance: “Although the audits undertaken had identified some areas for improvement, they had not been effective in identifying the areas for improvement that we found.”
moderateLeadership: “The registered manager who was also the provider had not ensured their responsibility to keep people safe through safe recruitment practices was met.”
minorRecord keeping: “Systems were not in place to ensure all records, such as care plans included a date that they were written. This makes it difficult to know if the care plans are up to date and valid.”
Strengths
· People and relatives spoke highly of staff and management; staff described as polite, caring and friendly.
· Medicines were managed safely by trained staff with competency assessments.
· Staff followed infection prevention and control procedures including COVID-19 guidance and PPE use.
· Personalised care with regular staff team enabling consistency; care plans reflected people's choices.
· Care calls took place within agreed timeframes supported by a live tracker.
Quality-Statement breakdown (19)
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
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 lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough; working with other agencies; accessing healthcareNot rated
caring: Ensuring people are well treated and supported; respecting equality, diversity, privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
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 requirementsRequires improvement
well-led: Promoting a positive culture; engaging and involving people; duty of candourNot rated
well-led: Continuous learning and improving care; working in partnership with othersNot rated