First inspection of newly registered domiciliary care agency rated Requires Improvement overall and across all five key questions, with breaches identified in safe care and treatment, fit and proper persons employed, staffing and good governance. Failings included poor risk recording, inadequate recruitment checks, gaps in staff training oversight, weak quality assurance systems and inappropriate language in care plans.
Concerns (10)
criticalCare planning: “Risks to people were not always recorded and information provided to staff did not always mitigate risks.”
criticalStaff competency: “Recruitment measures at the service were not robust. Some checks had not been completed on staff before they started working”
criticalStaff training: “The provider had not taken steps to ensure their staff had the knowledge and skills to fulfil their roles.”
criticalGovernance: “There were ineffective systems to assess, monitor and improve the quality of the service”
moderateInfection control: “The provider was not following government guidance on infection prevention and control.”
moderatePerson-centred care: “Care plans were not always person centred... used language which did not identify or relate to the person who the care plan was about.”
moderateCultural competency: “we saw the use of inappropriate language which some might find offensive. We saw the term "straight" used to refer to someone's sexuality.”
moderateRecord keeping: “the service did not maintain securely an accurate, complete and contemporaneous record in respect of each service user.”
minorMedication management: “We recommend the provider follow best practice guidance on managing medicines safely.”
minorEnd-of-life care: “Care plans did not contain information about people's end of life wishes.”
Strengths
· Staff were trained to safeguard adults from abuse and there had been no incidents or accidents at the service.
· People and relatives told us staff treated people well; people's privacy and dignity were respected and their independence promoted.
· People consented to their own care and staff understood the law in this regard (MCA).
· People's nutrition and hydration needs were met.
· Staff received supervision from the provider every three months.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Learning lessons when things go wrongNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: End of life care and supportNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
well-led: Promoting a positive culture; Continuous learning and improving careNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Duty of candourNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated