Casa Care Ltd, a domiciliary care agency in Leamington Spa, was rated Requires Improvement overall at its January 2023 inspection, down from Good in 2019, due to persistent late and missed care calls, non-personalised risk management plans, ineffective governance systems, and poor communication from office management. Care staff were consistently praised as kind and competent, and medicines, infection control and partnership working were managed well.
Concerns (9)
moderateCare planning: “risks related to choking, diabetes and catheter care... staff did not have specific information to refer to... risk management was not personalised to the individual.”
moderateMissed or late visits: “The carers should arrive for 7.00am so I then have time to get to my hospital appointment, but often they arrive at 7.45am which is too late.”
moderateRecord keeping: “one person's care plan directed staff to prepare 'mashed' food but later referred to 'pureed food' being required.”
moderateStaff competency: “Some staff are unsure about the hoist, so I help them with it. A staff member: New staff don't always know how to use the hoist or a slide sheet.”
moderateGovernance: “The provider's systems and processes had not identified potential risks to people. Staff were unable to refer to detailed person specific risk management plans.”
moderateCommunication with families: “Whilst the care staff communicate well with us, the office staff do not. Another person told us, The office staff and management are awful.”
minorComplaints handling: “one person had complained about a care staff member. Despite office staff giving them assurances that the staff member would not be sent to them again, the staff member was.”
minorSafeguarding: “one staff spoken with was unable to recall knowledge from their safeguarding training or what they should do if they suspected abuse.”
minorSupervision / appraisal: “spot checks that took place to ensure staff had the skills they needed were not consistently effective in relation to new staff.”
Strengths
· People felt safe with staff and described care staff as kind, caring and compassionate.
· Staff were recruited safely with appropriate pre-employment checks including DBS.
· Medicines were managed safely with an electronic monitoring system alerting office staff to missed doses.
· Staff promoted people's privacy, dignity and independence during personal care.
· The provider worked in partnership with healthcare professionals including district nurses and GPs.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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 live healthier lives, access healthcare services and supportGood
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 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: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
well-led: Managers being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Continuous learning and improving care; Working in partnership with othersGood