Action 2 Care improved from Requires Improvement to Good across all five key questions at this February 2023 inspection, demonstrating effective leadership and person-centred care for its four supported living and domiciliary care clients. Minor gaps in electronic medication records and completion of some condition-specific staff training were noted but did not affect the quality of care delivered.
Concerns (2)
minor
Medication management
: “improvements were required to some electronic medication administration records to ensure medicines prescribed were individually recorded”
minorStaff training: “Improvements were needed to ensure staff undertook training in key areas linked to people's needs, health and wellbeing. For example, mental health, diabetes and epilepsy awareness.”
Strengths
· People were supported to have maximum choice and control of their lives in the least restrictive way possible
· Staff had a good understanding of people's needs and how to support people when they became anxious or distressed
· People were supported by a consistent staff team with whom they had developed supportive relationships
· The registered manager introduced an electronic system providing real-time oversight of care and support
· Systems and processes were in place to monitor quality through robust auditing and action plans
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
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 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 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; End of life care and supportGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; Continuous learning and improving careGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
Focused inspection of Action 2 Care found the provider had improved enough to no longer breach Regulations 12 and 17, but Safe and Well-led both remained Requires Improvement. Concerns persisted around incomplete risk assessments, a missed call, medicines risk-assessment compliance, recruitment risk-assessment timing and gaps in quality assurance audits.
Concerns (7)
criticalMissed or late visits: “A missed call had recently occurred which put a person at risk of not receiving food and medication.”
moderateMedication management: “staff did not always follow the risk assessment of avoiding medicine having to be administered if not necessary. This meant a person was provided with medicine they may not have needed.”
moderateCare planning: “risk assessments were not always detailed to reduce all potential risks, such as managing distressed behaviour or managing continence.”
moderateStaff competency: “a risk assessment for a staff member with concerns regarding their background had not been put into place until after they had commenced employment.”
moderateGovernance: “safety issues we identified such as having detailed risk assessments for continence and distressed behaviours had not been identified through the auditing system.”
minorSupervision / appraisal: “Spot checks on staff took place to monitor whether staff were providing appropriate care and a positive approach to people, though these were not frequent.”
minorComplaints handling: “A small number of issues had been raised in the surveys though there was no action plan to address these.”
Strengths
· Care plans reflected people's individual needs and preferences
· Enough staff employed to meet people's needs and timely calls were in place
· Registered manager understood their responsibilities and worked in an open and transparent way
· People and relatives were positive about the registered manager and felt listened to
· Staff demonstrated understanding of safeguarding and were confident management would act on concerns
Quality-Statement breakdown (11)
safe: Using medicines safelyNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
well-led: Continuous learning and improving careNot rated
well-led: Duty of candourNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated