This focused KLOE inspection of Virtus Care LTD found the service had made sufficient improvements since its previous 'Requires improvement' rating in 2019, with the previous breach of Regulation 12 now remedied. Both Safe and Well-led key questions were rated Good, resulting in an overall Good rating.
Strengths
· Risk assessments were comprehensive, reviewed when health needs changed, and covered mobility, falls, skin integrity, medicines, nutrition, hydration and home environment risks.
· Medicines were managed safely with trained and competent staff; MARs were completed appropriately with photographs and comprehensive medicine lists in care records.
· Safe recruitment processes including DBS checks and employment references were consistently followed before staff commenced employment.
· Effective infection prevention and control procedures were in place with appropriate PPE access and staff training.
· The registered manager demonstrated clear understanding of regulatory requirements and submitted CQC notifications appropriately.
Virtus Care LTD, a small domiciliary care agency supporting one person at the time of inspection, was rated Requires Improvement overall due to a breach of Regulation 12 relating to inadequate risk assessment processes and insufficient documentation around crushing and administering medicines via PEG. Caring, Effective, and Responsive domains were rated Good, with strong person-centred practice and positive feedback from the person using the service, but governance systems failed to identify the safety shortfalls found.
Concerns (5)
criticalCare planning: “Risk assessments were not always being reviewed and updated to reflect people's changing healthcare needs.”
criticalMedication management: “the registered manager told us that they were currently crushing one person's medicines before administering via a PEG... we did not see appropriate guidance in place”
moderateGovernance: “auditing systems were not always identifying the shortfalls we found in relation to risk assessment processes.”
moderateStaff training: “staff had yet to complete training in stroke and epilepsy awareness despite already providing care to a person with both of these conditions.”
minorRecord keeping: “employment references sent by email lacked company stamps/logos and the full professional title of referees.”
Strengths
· People told us they felt safe and trusted the staff providing care and support.
· Care plans were person-centred and people's choices were respected in all aspects of their care.
· Safe recruitment processes were being followed to ensure staff were suitable for their roles.
· Staff supported people to take their medicines safely where this formed part of an agreed package of care.
· People spoke highly of staff; one person said 'I have the best carers in Britain.'
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
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 and access healthcare servicesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
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 controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff 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 empoweringGood
well-led: Engaging and involving people using the service; continuous learning and improving careGood
well-led: How the provider understands and acts on the duty of candourGood