This assessment took place between 19 March and 16 April 2024. Competent Healthcare Ltd is a domiciliary care agency providing personal care services to people in their own homes. The service specialises in providing care for older adults. During this assessment we looked at parts of 4 key questions, safe, effective, caring and well led. We identified breaches in regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service combines scoring from the key questions we looked at during this assessment and key question scores in line with findings from our last inspection, where the service was rated good. There was not an effective governance system in place to monitor and improve the quality of care and safety of the service. Auditing and quality assurance information was not always available for inspectors to review. Completed audits were not always effective in identifying issues which needed to be addressed. The provider did not always robustly assess and reduce risks related to people’s care needs and medicines management. Care planning was not always clear about the specific support people required and how staff should support people to manage identified risks. The provider had systems in place to identify, record and report safeguarding concerns to relevant authorities. However, there was limited evidence that incidents were fully investigated to reduce the risk of recurrence. The provider did not always ensure their processes were fully in line with The Mental Capacity Act 2005 when people lacked capacity to make decisions about their care. There were enough staff in place to meet people’s needs, although staffing contingencies were not fully assessed, meaning it was unclear whose care should be prioritised in the event of an emergency.
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Competent Healthcare Ltd improved from Requires Improvement to Good across all five key questions, having remediated previous breaches of Regulations 17 and 18. The service demonstrated sustained improvements in governance, staffing, training and person-centred care delivery, with consistently positive feedback from people, relatives and health professionals.
Concerns (2)
minorRecord keeping: “The registered manager had recognised where people's care plans required updating to include more detailed background about people's life, medical conditions and specific personal care routines.”
minorSafeguarding: “We found the provider needed to update information in their safeguarding policy around their safeguarding lead and local authority contacts.”
Strengths
· Significant improvements in governance processes and quality monitoring systems since previous inspection
· Clear management structure with defined roles and responsibilities for senior staff
· Staff received comprehensive training including practical courses covering safeguarding, first aid and moving and handling
· Consistent staffing arrangements with people supported by familiar care staff at regular times
· Positive culture with approachable and professional leadership praised by people, relatives and staff
Quality-Statement breakdown (24)
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
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 guidanceGood
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: Improving care quality in response to complaints or concernsGood
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 requirementsGood
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 staffGood
well-led: Continuous learning and improving careGood