Rupaal Care and Training Ltd was rated Requires Improvement overall, with a breach of Regulation 17 (Good Governance) due to reliance on a sub-contracting agency's records rather than maintaining its own complete, contemporaneous care records. All five key questions were rated Good except Well-Led, and people's experience of care was positive with no evidence of harm.
Concerns (5)
critical
Record keeping
: “The service did not maintain accurate, complete and contemporaneous records in respect of people receiving care and support.”
criticalGovernance: “We found that the service did not always assess specific risks associated with people's care, maintain their own contemporaneous records...Instead they relied on...the sub-contracting agency.”
moderateCare planning: “Care plans did not always contain enough information about the support the person required.”
moderateConsent / capacity: “Where people did lack capacity to make specific decisions...the service had not documented any information relating to this and...decisions made in the persons best interests had not been recorded.”
moderateSupervision / appraisal: “Records confirming supervision and annual appraisals were not always available...supervisions and annual appraisals were not always formally recorded.”
Strengths
· People and relatives felt safe and spoke positively about care staff, describing them as kind, caring and nice.
· Medicine Administration Records were complete with no gaps in recording identified.
· Staff received induction, training, safeguarding awareness and knew how to whistle-blow.
· Complaints were recorded, investigated and responded to in line with the provider's complaints policy.
· The registered manager understood the duty of candour and CQC notification responsibilities.
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
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 working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidance (MCA)Requires improvement
caring: Ensuring people are well treated and supported; respecting 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: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff; working in partnership with othersGood
Rupaal Care and Training Ltd improved from Requires Improvement to Good following a focused inspection of Safe and Well-led, having fully remediated a prior breach of Regulation 17 (Good Governance). People and relatives reported feeling safe and satisfied with care, and the registered manager had successfully embedded audits, electronic monitoring, and governance systems since the last inspection.
Strengths
· Care plans were person centred and contained detailed risk assessments covering environment, social, care and medical needs
· Medicine administration records were complete with no gaps; monthly audits conducted by registered manager
· Regular team of care staff who arrived on time; people and relatives spoke positively of consistency
· Registered manager introduced electronic call monitoring and care planning system to monitor timekeeping and attendance
· Audits, spot checks and six-monthly care plan reviews implemented since last inspection to monitor quality
Quality-Statement breakdown (9)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff; Working in partnership with othersGood
Rupaal Care and Training received an overall rating of Requires Improvement following a January 2016 inspection, with five regulatory breaches identified covering medication management, risk assessment, recruitment, consent/MCA, staffing support, and governance. The service demonstrated strengths in caring practice and person-centred support, but systemic failures in training, supervision, quality monitoring, and record-keeping posed risks to people using the service.
Concerns (8)
criticalMedication management: “Staff were not suitably trained to administer medicines in line with legislation, guidance and as per the organisation's medicines policy.”
criticalCare planning: “Risk assessments were completed by the local authority and not by the service. This meant people who used the service and staff were potentially at risk of accident and injuries.”
criticalConsent / capacity: “The provider did not act in accordance with the Mental Capacity Act 2005. The service did not have a policy on the Mental Capacity Act.”
criticalStaff competency: “The service did not have robust recruitment process. The registered manager told us the service did not have a recruitment policy and procedure.”
moderateStaff training: “The registered manager told us that induction for new staff was completed in six and half hours... we were not assured the induction programme prepared staff for their role.”
moderateSupervision / appraisal: “One staff member had no recorded supervision since September 2014. We asked the registered manager why the staff member had not had supervision.”
moderateGovernance: “The systems in place to regularly assess and monitor the quality of services provided were not effective, and were not undertaken on a regular basis.”
moderateRecord keeping: “Records were not always accurate, up to date and easily accessible... it was not clear what staff had completed training.”
Strengths
· People and their relatives reported feeling safe and expressed high satisfaction with the caring attitude of staff.
· Staff demonstrated good understanding of safeguarding adults responsibilities and escalation procedures.
· Care plans were detailed and person-centred, with people involved in planning their own care.
· Sufficient staffing levels were maintained and staff were reported as punctual with no missed visits.
· Staff respected people's privacy and dignity, with good knowledge of individual preferences and needs.
Quality-Statement breakdown (16)
safe: Medication managementRequires improvement
safe: Risk assessmentRequires improvement
safe: RecruitmentRequires improvement
safe: SafeguardingGood
safe: Staffing levelsGood
effective: Consent and Mental Capacity ActRequires improvement
effective: Staff training and inductionRequires improvement
effective: Supervision and appraisalRequires improvement
Rupaal Care and Training Ltd was rated Good across all five key questions at this December 2016 inspection, having successfully addressed all breaches identified at the previous January 2016 inspection relating to medicines, risk assessment, consent, quality assurance, recruitment and training. The service demonstrated safe, person-centred care underpinned by strong leadership, effective staff training and robust quality monitoring systems.
Strengths
· People felt safe and trusted staff, with positive feedback on punctuality and reliability of visits
· Medicines management improved since previous inspection, with spot checks, competency observations and medicine record audits in place
· Staff received regular supervision, appraisal and a good level of training including mandatory and vocational qualifications
· Care plans were person-centred, signed by service users, and regularly reviewed to reflect changing needs
· Strong, hands-on registered manager praised by staff, people and social care professionals for responsiveness and approachability
Quality-Statement breakdown (18)
safe: Risk assessment and mitigationGood
safe: Medicines managementGood
safe: SafeguardingGood
safe: Recruitment proceduresGood
safe: Staffing levelsGood
effective: Staff trainingGood
effective: Supervision and appraisalGood
effective: Mental Capacity Act complianceGood
effective: Nutrition and health needs
Good
caring: Kindness, respect and compassionGood
caring: Privacy and dignityGood
responsive: Person-centred care planningGood
responsive: Complaints handlingGood
well-led: Quality assurance and governanceRequires improvement
well-led: Record keepingRequires improvement
well-led: Leadership and cultureGood
effective: Nutrition and hydration support
Good
caring: Dignity, respect and privacyGood
caring: Person-centred and culturally sensitive careGood