Sanctuary Life Care Limited is a domiciliary care service providing personal care to older people and younger adults living in their own homes who have dementia, mental ill health, a learning disability or autism spectrum disorder, sensory impairment and/or a physical disability. At the time of our assessment, 1 person was in receipt of personal care. There was no one being supported with a learning disability. This assessment was completed on 26 February 2024 and was carried out to follow up on action we told the provider to take at the last inspection to ensure they had met the requirements of the warning notice we previously served. During this assessment we found staff recruitment and development, the management of risk associated with people’s care, people’s medicines and the providers systems and processes to monitor the quality and safety of the service had improved. The provider was no longer in breach of the regulations. However, further time was needed to demonstrate these improvements had been embedded and could be sustained as the business grew. We only looked at 7 quality statements; Safeguarding; Involving people to manage risks; Safe and effective staffing; Safe systems, pathways and transitions; Independence, choice and control; Medicines optimisation and Governance, management and sustainability. We will assess the other quality statements in future assessments.
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safe:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This targeted KLOE inspection of Sanctuary Life Care Limited found continued breaches of Regulations 12, 17 and 19, with insufficient improvement since the previous Inadequate rating, particularly in recruitment, risk assessment, medicines management and governance. The overall rating remains Inadequate from the prior inspection; targeted inspections do not reassign ratings.
Concerns (8)
criticalStaffing levels: “DBS checks had not been requested by the provider in line with their recruitment policy.”
criticalStaff competency: “Recruitment information was not obtained in accordance with the providers policies and procedures to demonstrate staff were of good character.”
criticalStaff training: “There was no clear evidence that staff had completed regular training to update their skills and knowledge to enable them carry out their roles effectively.”
criticalCare planning: “Potential risks associated with people's needs were not always identified and assessed to ensure there was clear guidance to staff on how to respond.”
criticalGovernance: “Audits systems continued not to be fully effective in identifying areas needing improvement to ensure the quality and safety of the service was maintained.”
moderateMedication management: “There were no body charts completed to show where the cream should be applied. The medicine administration record also did not provide instructions for staff.”
moderateRecord keeping: “Care records and risk assessments were either insufficiently detailed or not in place which meant staff did not have the information they needed.”
moderateIncident learning: “Opportunities for continuous learning and improving care had been missed because the provider did not have effective systems and processes to identify where improvements may be needed.”
Strengths
· Safeguarding systems improved sufficiently to no longer be in breach of Regulation 13; staff understood reporting responsibilities.
· A relative spoke positively of the care provided and raised no concerns regarding the safety of their family member.
· Provider implemented new medicine charts following the last inspection to confirm medicines people needed support with.
· Provider had a system in place to notify CQC of significant events and recognised the duty of candour.
· Staff felt supported by the registered manager and deputy manager.
Quality-Statement breakdown (7)
safe: Staffing and recruitment (Regulation 19 – Fit and proper persons employed)Insufficient evidence to rate
safe: Assessing risk, safety monitoring and management (Regulation 12 – Safe care and treatment)Insufficient evidence to rate
safe: Using medicines safelyInsufficient evidence to rate
safe: Systems and processes to safeguard people from the risk of abuse (Regulation 13)Good
well-led: Promoting a positive culture; governance and regulatory requirements (Regulation 17 – Good Governance)Insufficient evidence to rate
well-led: Continuous learning and improving careInsufficient evidence to rate
Sanctuary Life Care Limited received an overall Inadequate rating at its first inspection in July 2022, with breaches of Regulations 12, 13, 17 and 19 resulting in Warning Notices and placement in special measures. Critical failures in risk assessment, medicines management, safeguarding escalation, staff recruitment checks and governance were widespread, though relatives reported caring staff attitudes and timely visits.
Concerns (11)
criticalSafeguarding: “the safeguarding incident had not been escalated to all agencies as required. There was no safeguarding log showing any safeguarding incidents that had occurred.”
criticalMedication management: “Staff and relatives confirmed creams were applied to people's skin. There were no body maps completed...or medicine charts completed...to show when staff had applied creams.”
criticalCare planning: “One person's care record stated they needed 'help to have a wash and personal care' but there was no further information to inform staff what was required and how to complete this task safely.”
criticalGovernance: “The provider failed to operate systems or processes to assess, monitor and improve the quality and safety of the services provided. Accurate, complete and contemporaneous records...were not maintained.”
criticalRecord keeping: “Records had not been sufficiently maintained to enable the provider to review records and identify when things had gone wrong.”
criticalLeadership: “The lack of managerial oversight meant information was lacking in relation to staff recruitment and training to ensure staff were safe and suitable to provide care to people.”
moderateStaff training: “At the time of our inspection there was no training matrix in place showing completed training for staff...this did not provide a clear overview of training such as when it was completed and when it expired.”
moderateStaff competency: “The registered manager was not able to provide evidence of staff competency checks to assure themselves staff provided safe, quality care in line with their expectations.”
moderateIncident learning: “A monitoring activity completed by CQC in June 2021 had identified improvements were needed including records management...we saw these improvements had not been acted upon.”
moderatePerson-centred care: “Care records were either insufficiently detailed or were not in place which meant staff did not have the information they needed to provide safe, person-centred care.”
minorEnd-of-life care: “One person's care plan stated they had a 'ReSPECT' in place but this was not available within the care records shared. This was important to help ensure the persons wishes were followed.”
Strengths
· Sufficient numbers of staff employed to complete care calls required.
· Relatives confirmed staff were kind, respectful, patient and caring towards people.
· Staff followed infection prevention and control guidance; adequate PPE supply maintained throughout.
· Staff worked with GPs, district nurses and commissioners to support people's healthcare needs.
· Staff demonstrated understanding of MCA principles and consent in practice.
Quality-Statement breakdown (23)
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Learning lessons when things go wrongInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choicesRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enoughGood
effective: Staff working 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; respecting equality and diversityRequires improvement
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 controlRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Promoting a positive culture; managers and staff being clear about their roles and regulatory requirementsInadequate
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Continuous learning and improving careInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate