Your Care Services was rated Good overall for its November 2015 inspection, with staff providing safe, caring and effective support to 26 people with complex needs, underpinned by strong training and recruitment processes. However, the Well-Led domain required improvement due to ineffective governance audits, failure to notify CQC of safeguarding events, incomplete incident records, and insufficient systems to identify and act on trends.
Concerns (6)
critical
Safeguarding
: “The provider and registered manager had not notified us about some safeguarding events that they were required to by law.”
moderateGovernance: “these audits had failed to identify that two people using the agency did not have care plans that contained guidance about all of their health needs”
moderateIncident learning: “A log was not maintained that identified the number and type of incidents occurring...This meant specific events were not recorded in ways which could highlight trends.”
moderateRecord keeping: “for one record that we looked at we saw the circumstances leading up to the incident had not been recorded so it was not clear how or why it had occurred”
moderateCare planning: “one care staff we spoke with did not know a person they had provided care to had diabetes...there was a risk the member of staff might not recognise when the person was unwell”
minorMissed or late visits: “Detailed records or analysis of late calls were currently not available...call timings were not on the care plan this meant that people may not be clear about the times”
Strengths
· Staff demonstrated compassion and detailed knowledge of individual people's needs, preferences and routines
· Thorough recruitment process including DBS checks and references before staff commenced work
· Structured induction including Care Certificate standards and supervised shadow shifts
· Regular refresher training programme and specific competency assessment for complex health procedures
· Complaints were recorded, investigated in a timely manner and responsive to people's concerns
Your Care Services achieved a Good rating across all five key questions at this announced inspection of 21 February 2017, demonstrating improvements since the November 2015 inspection particularly in quality monitoring systems. Minor gaps were noted in care plan documentation detail and written analysis of incidents for trend identification, but no regulatory breaches were identified.
Concerns (4)
minorCare planning: “For one person staff were giving their medication in a specific way but the care plan was not detailed and did not evidence why medication was being administered by this method.”
minorRecord keeping: “Whilst a written analysis of these was not kept to help identify themes and trends the registered manager demonstrated a good awareness of issues that had occurred.”
minorGovernance: “The format of these sometimes made it difficult to track the progress that was made or when an action had been completed.”
minorPerson-centred care: “I do have a problem with continuity of care. I have my primary carer but they keep changing the second one. I find it frustrating.”
Strengths
· Staff demonstrated compassion and went above and beyond, including fetching personal effects for a hospitalised person and supporting families at distressing times.
· Thorough recruitment process including DBS checks and references completed before staff commenced work.
· Robust induction programme including Care Certificate standards and four-week shadow shifts alongside experienced staff.
· Electronic call monitoring system implemented since last inspection to ensure people received agreed care visits.
· Computerised call logging system introduced to alert office staff if staff had not logged in at a care call.
Your Care Services Brain Injury Specialists Limited achieved a Good rating across all five key questions at its September 2019 inspection, maintaining its previous Good rating from 2017. The service demonstrated strong person-centred care for 18 people with complex needs, with consistent staffing, robust risk management, specialist staff training, and effective partnership working with health professionals.
Strengths
· Consistent staffing with named weekly rotas provided to people, enabling planning and continuity of care
· Staff received specific training for complex needs including PEG care, epilepsy management, hoist use and end of life care
· Medicines administered safely with competency checks and monthly audits of medicines administration records
· People and relatives highly complimentary of management responsiveness and emotional support provided
· Person-centred care plans detailed individual preferences, communication needs, life histories and interests
Quality-Statement breakdown (25)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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 careGood
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 concernsGood
responsive: End of life care and supportGood
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
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 staffGood
well-led: Continuous learning and improving careGood