Care-D/UK received an overall Inadequate rating following a May 2022 inspection, with the service placed in special measures due to persistent and unaddressed breaches across five regulations including safe care, safeguarding, staffing, recruitment, and governance. Chronic missed and late visits, insufficient staffing, ineffective audits, and a failure to learn lessons from the previous inspection placed people at continued risk of harm.
Concerns (14)
criticalMissed or late visits: “We've had a lot of problems with missed visits and late calls. There are times when they just don't come. If the carers don't visit it means [my person] doesn't get a wash.”
criticalStaffing levels: “There are not enough staff here and there haven't been enough for a while. There are definitely not enough staff.”
criticalSafeguarding: “There was also still no meaningful analysis of safeguarding themes and trends. The provider had failed to reduce the risk to people and learn lessons from incidents.”
criticalGovernance: “Audits carried out were not effective, and there was no clear action plan linked to observations made. No entries for nine care visits over eight days with no follow-up.”
criticalStaff competency: “Staff files did not always demonstrate the provider had checked staff were safe and suitable for the role. Gaps in employment history not explored, references not completed.”
criticalIncident learning: “Lessons had not been learned from the previous inspection and numerous shortfalls had not been addressed. Limited action had been taken to resolve shortfalls identified at the last inspection.”
criticalLeadership: “The provider could not demonstrate oversight of the quality and safety of the service. This had led to the local authority commissioners placing a suspension on the service.”
moderateRecord keeping: “Records were not always completed, which meant changes to people's care needs might be missed. Poor record keeping also created a risk people were not receiving enough to eat and drink.”
moderateSupervision / appraisal: “Staff told us they were not always given regular formal supervisions. One care worker said, 'I do not know what a supervision is, and I don't think I have ever had a 1:1 with my manager.'”
moderateInfection control: “Some care workers did not wear PPE in a way that followed government guidance, and people we spoke with were not confident staff always washed their hands.”
moderatePerson-centred care: “I have no rota. I have no idea who is going to come and at what time. They try to rush me, and I have to tell them to stop and wait because I'm out of breath.”
moderateComplaints handling: “The provider did not carry out any analysis of themes and trends in complaints, to demonstrate how they acted to improve the service in response to people's feedback.”
moderateConsent / capacity: “There was no evidence of formal capacity assessments or detailed best interests decision making within the care plans of people living with dementia.”
moderateMedication management: “As the notes were not being consistently completed it was not always clear whether people had taken their medicines as prescribed. We found a tablet on the floor.”
Strengths
· Staff received training on specific health conditions such as diabetes and epilepsy.
· Staff received spot checks where their performance was assessed during visits and feedback provided.
· The provider worked with other organisations and agencies, such as GPs, occupational therapists, paramedics and the local authority.
· An Accessible Information Standard policy and procedure was in place, with information available in different formats upon request.
· A duty of candour policy was in place setting out the need to be open and transparent when things go wrong.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
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 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 staffRequires improvement
Care-D/UK, a domiciliary care agency in Southend-on-Sea, received an overall rating of Requires Improvement on its first inspection, with breaches of Regulations 12, 13, and 17 identified relating to unsafe risk management, unreported safeguarding concerns, and inadequate governance. While staff were trained and people spoke positively of their regular carers, systemic failures in monitoring missed visits, completing care records, and escalating safeguarding issues placed people at risk of harm.
Concerns (9)
criticalSafeguarding: “The local authority had received several complaints in relation to missed calls and these were raised as safeguarding's. None of these safeguarding's had been reported to CQC by the provider.”
criticalMissed or late visits: “There was not a robust system in place to monitor missed and late visits effectively. Whilst an electronic process was in place the registered manager told us staff were not using the system correctly.”
criticalGovernance: “Systems and processes were not robust enough to demonstrate quality and safety were effectively managed. This placed people at risk of harm. This was a breach of regulation 17 (Good Governance).”
moderateCare planning: “Two people's assessments did not always contain all the information staff required to meet people's needs. For example, guidance on supporting two people with epilepsy.”
moderateRecord keeping: “People's care notes were not always being completed on all visits. This meant the care team did not always have access to the latest information to reflect people's changing needs.”
moderateIncident learning: “No related themes or trends had been explored in relation to these concerns at the time they were raised.”
moderateComplaints handling: “Complaints had not always been appropriately investigated to make improvements and prevent a reoccurrence. There was no outcome or action recorded.”
moderateStaff competency: “Three staff we spoke with could not tell us who to report to externally. A staff member told us, 'I would report any concerns straight to the manager.'”
minorPerson-centred care: “Some staff stay the full amount of time, but some do what they need to then leave.”
Strengths
· Staff were trained and competent in their role and received supervision and appraisals.
· Staff had access to appropriate PPE and infection prevention and control policy was up to date.
· People spoke positively about regular staff, describing them as kind and caring.
· Staff received additional training to meet specific needs, such as epilepsy training.
· People were supported to have maximum choice and control in line with MCA principles.
Quality-Statement breakdown (19)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experience
Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
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: Respecting and promoting people's privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood