Advantage Healthcare - South Coast received an overall rating of Requires Improvement following a focused January 2023 inspection, with Safe, Effective and Well-Led all remaining at that rating for a second consecutive inspection cycle. Key shortfalls centred on incomplete medication records, insufficiently individualised risk assessments, poor documentation of mental capacity assessments, and governance systems that failed to detect these gaps in care records.
Concerns (5)
moderateMedication management: “Body maps were not always used effectively to show where topical creams should be applied. Records did not clearly show how risks related to emollient creams should be mitigated.”
moderate
Consent / capacity
: “The service did not always robustly record assessment of mental capacity and how decisions were made in people's best interests.”
moderateRecord keeping: “Some care and medicine records lacked detail about the care provided to people. Audits and reviews of care records were carried out at the branch but had not identified gaps.”
moderateGovernance: “Provider governance was not always effective in identifying areas for improvement...these did not identify improvements required in care records.”
moderateCare planning: “Some risk assessments were focused on organisational or generic risks, rather than those experienced by the individual person. Risk management plans therefore sometimes lacked detail.”
Strengths
· Staff were safely recruited with appropriate DBS checks and suitability assessments in place.
· Safeguarding policies and training were in place; relatives had confidence in staff and managers to respond to concerns.
· Staff received specific training for equipment and health needs of the people they supported.
· People's nutritional needs were managed effectively with preferences and SALT referrals recorded.
· Staff worked closely with specialist health teams and professionals for complex health needs.
Quality-Statement breakdown (14)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidance (MCA)Requires improvement
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
well-led: Managers and staff being clear about their roles; 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
Interserve Healthcare South Coast received an overall rating of Requires Improvement at its first inspection under the current registration, with a regulatory breach identified for staffing due to missed visits and failure to plan for unplanned absences. While the service demonstrated strengths in personalised, dignified care and safeguarding, recurring issues with staffing reliability, MAR recording errors, inconsistent staff competency, and the absence of a registered manager undermined safety, effectiveness and governance.
Concerns (8)
criticalStaffing levels: “Staff let you down at the last minute, it makes it difficult not knowing that staff aren't going to come.”
criticalMissed or late visits: “A shift had been missed for three consecutive nights and that due to this the family had changed their care provider.”
moderateRecord keeping: “We saw gaps and errors in recording in Medication Administration Records (MARs) from people's homes.”
moderateMedication management: “Audits used to monitor medicines identified these gaps, but the provider did not always take action informed by these audits.”
moderateStaff competency: “A commissioner told us that staff did not always have the relevant experience and training.”
moderateGovernance: “Management staff and the provider did not monitor shifts where a support worker had arrived late or where missed shifts had been covered by an agency staff member.”
moderateLeadership: “At the time of our inspection, there was no registered manager.”
minorSupervision / appraisal: “Staff told us there had been a gap in team or peer meetings since the change in manager.”
Strengths
· Robust recruitment systems ensured staff were safe to work in a social care setting with values-based interview questions and DBS checks.
· People were treated with kindness, dignity and respect; diverse needs and preferences were identified and reflected in personalised support plans.
· Safeguarding systems were effective; staff had good knowledge of safeguarding processes for adults and children.
· Care plans were bespoke and personalised, reflecting individual needs, hobbies, communication styles and health conditions.
· Complaints were recorded and investigated promptly, and people knew how to raise concerns.
Quality-Statement breakdown (20)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safely; Learning lessons when things go wrongRequires improvement
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: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff working with other agencies to provide consistent, effective, timely care
Good
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: Continuous learning and improving careRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people, staff and promoting a positive cultureGood