Blessed Hearts Home Care improved from Inadequate to Requires Improvement overall following a focused inspection, exiting Special Measures, with Good achieved in Effective; however, ongoing concerns around late and missed visits, absent MAR charts, gaps in care planning detail, and audit failures to detect medicines management issues meant Safe, Caring and Well-led remained Requires Improvement.
Concerns (9)
criticalMedication management: “We found two peoples care records did not contain a medication administration record (MAR) or body maps to guide staff where to apply their prescribed creams.”
criticalMedication management: “A staff member was helping another person's relative administer their medication without a MAR chart in place.”
moderateMissed or late visits: “most of the relatives we spoke to told us their family members continued to experience late calls and some relatives told us their family members occasionally experienced missed calls.”
moderateCare planning: “some people's care records required clearer information for staff to follow to support people with specific health conditions, such as diabetes.”
moderateRecord keeping: “we did identify unexplored gaps in staff members' employment history”
moderateGovernance: “the provider had failed to identify two people were receiving staff support with their medicines without a MAR chart.”
moderatePerson-centred care: “People's preferences in relation to their care calls times were not met, and they had experienced late and, sometimes, missed calls. This did not reflect a caring approach.”
minorCommunication with families: “Two people's relatives felt their concerns about their family members' care had not always been responded to appropriately.”
minorGovernance: “the action taken in response to any negative feedback was not always clearly recorded.”
Strengths
· Staff received training tailored to the needs of the people they supported, including the Care Certificate and moving and handling training reflecting individual needs.
· Recruitment processes improved; all staff had DBS checks prior to commencing work and staff with criminal records had robust risk assessments.
· Infection control practices improved; staff wore full PPE and spot checks included observation of infection control practices.
· Accidents and incidents were recorded, investigated and action taken to reduce risk of reoccurrence.
· People were supported to have maximum choice and control; staff worked within MCA principles.
Quality-Statement breakdown (16)
safe: Assessing risk, safety monitoring and management; Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Using medicines safelyRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
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 careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Working in partnership with othersGood
well-led: How the provider understands and acts on the duty of candourGood
Blessed Hearts Home Care was rated Inadequate overall following a focused inspection in March–April 2021, with enforcement conditions placed on its registration for continued breaches of Regulations 12, 17, and 19. Widespread failures in staff recruitment, missed and late care calls, unsafe moving and handling, poor infection control, and ineffective governance left people at risk of avoidable harm.
Concerns (16)
criticalStaffing levels: “Feedback from people and relatives consistently reported incidents of care calls being late, missed or a single carer attending when two staff were required to meet the person's needs.”
criticalMissed or late visits: “The morning call was 90 minutes late which meant the person had recently had breakfast when carers then arrived to support with lunchtime.”
criticalStaff competency: “Staff records did not detail the specific equipment that individual staff were trained to use... regular staff competencies in moving and handling techniques were not yet completed.”
criticalInfection control: “Carers wore the same gloves for all tasks, including after carrying out personal care or applying creams... staff wore the same apron for personal care and food preparation.”
criticalSafeguarding: “We were informed of incidents of potential abuse that were not raised with the safeguarding team.”
criticalIncident learning: “A person who required two carers to receive personal care safely had been supported by a single staff member. The manager had been aware of this incident, but no further action had been taken.”
criticalGovernance: “Any audits implemented were ineffective in identifying the concerns we highlighted about safety, people's experience of care and the governance of the service.”
moderateRecord keeping: “One person's care plan recorded a number of time sensitive medications they needed carers to administer. However, the person's daily records did not detail whether support with medication was taking place and MAR were unavailable.”
moderateMedication management: “There were no audits of people's medication charts. This meant potential medication errors could not be highlighted and learned from.”
moderatePerson-centred care: “People consistently told us they had not been involved in reviews of their care. Some people told us concerns about the outcome should they express their views.”
moderateCommunication with families: “Feedback from people and relatives informed us that communication with the service was inconsistent. Some people were not updated about changes to their care calls or informed about delays.”
moderateStaff training: “Training records showed that only half of staff were up to date with Infection Prevention Control training.”
moderateCare planning: “Plans were not always reviewed in line with the provider's own policy. For example, the risk assessment for a person at high risk of pressure areas had not been reviewed regularly.”
moderateComplaints handling: “The system in place to monitor feedback and complaints from people was not robust. The process in place was not consistently followed or reviewed in line with the provider's own timescales.”
moderateSupervision / appraisal: “Staff competency in areas such as medication management, moving and handling or infection control was not regularly monitored.”
moderateLeadership: “There has been no registered manager in post since February 2021.”
Strengths
· A person whose first language was Punjabi was supported by Punjabi speaking staff, demonstrating consideration of cultural needs.
· Some people reported that regular carers had supported them to increase their independence with incredible patience.
· Staff told us there was good communication with the new manager and felt able to raise any concerns.
· The provider understood their responsibility in relation to duty of candour.
· The new manager was open about areas of improvement required and took immediate steps to address concerns found during the inspection.
Quality-Statement breakdown (11)
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and management; Preventing and controlling infectionInadequate
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongInadequate
safe: Using medicines safelyRequires improvement
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 careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
Surecare Wolverhampton's first inspection resulted in an overall rating of Requires Improvement, with regulatory breaches identified in safe recruitment (Regulation 19), staffing and training (Regulation 18), and governance (Regulation 17). Whilst caring was rated Good and staff demonstrated compassion and cultural sensitivity, significant failings in oversight, staff training, recruitment checks, and medicines management placed people at risk of harm.
Concerns (7)
criticalStaffing levels: “one staff member had been working at the service without a Disclosure and Barring Service (DBS) check... three staff members had been working without valid references.”
criticalStaff training: “one staff member had been working without any training... staff supported a person with epilepsy however had not received training in this area.”
criticalGovernance: “the provider had failed to continuously and effectively monitor the quality of the service since they registered with us as they had not completed audits on any aspects of the service.”
moderateMedication management: “staff had signed for medicines the person told staff they had taken prior to their visit. This person was living with dementia and experienced periods of confusion.”
moderatePerson-centred care: “prior to the manager starting people did not consistently have regular reviews of their care.”
moderateRecord keeping: “training records had not been completed... The provider was unable to clarify whether this staff member had received training with a previous employer as their records were not complete.”
moderateSupervision / appraisal: “Quality assurance checks on medicines had not identified where staff had signed for medicines they had not administered and therefore where staff's competency required assessing.”
Strengths
· People felt safe and were supported by staff who understood how to protect them from abuse and had received safeguarding training.
· People had risk assessments in place providing staff with guidance to reduce risk, including for falls and skin breakdown.
· Staff treated people with kindness, compassion, dignity and respect, and promoted independence.
· People's cultural and communication needs were met, including being supported by staff who shared their first language.
· The new manager made significant improvements upon appointment, including reviewing staff files, enrolling staff on training, and implementing supervision and appraisals.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving care
Inadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; Engaging and involving people using the serviceInadequate
well-led: Working in partnership with othersRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
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 controlRequires improvement
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, 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