First inspection of a small domiciliary care agency supporting one person, rated Requires Improvement overall with one breach of Regulation 17 (good governance) due to inadequate audits and non-person-centred care plans. Caring was rated Good, with staff treating people with dignity and respect, but risk assessments, communication plans and personalisation of care needed improvement.
Concerns (8)
critical
Governance
: “Robust audit systems were not in place to ensure people received safe personalised care.”
criticalGovernance: “This was a breach of regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
moderateCare planning: “Risk assessments had not been completed in relation to people's health conditions to ensure risks associated with people's medical conditions were minimised”
moderatePerson-centred care: “Care plans were not person-centred and did not include people's preferences with care.”
moderateCommunication with families: “Communication plans included how people communicated but did not include how staff should communicate with people.”
moderateMedication management: “Audits had not been completed on medicines to ensure medicines were being managed safely”
moderateCare planning: “Care plans did not include the level of support people required with meals or drinks and did not include their preference with meals.”
moderateRecord keeping: “staff did not have access to detailed person-centred care plans to facilitate them providing care to people the way they preferred”
Strengths
· Staff were aware of how to safeguard people from abuse and had received safeguarding training
· Pre-employment checks had been carried out to ensure staff were suitable to work with vulnerable people
· Systems were in place to minimise risks of late or missed calls
· Medicines were being administered as prescribed according to MAR charts
· Staff had received training and induction including shadowing experienced staff
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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: Planning personalised care to ensure people have choice and control and to meet their needs and preferences; Meeting people's communication needsRequires improvement
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 requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood