Focused inspection found the service had deteriorated from good to requires improvement overall, with safe rated inadequate due to unsafe medication management, inadequate risk assessment, failed recruitment checks for a senior staff member, and inaccurate visit records. Well-led was rated requires improvement due to ineffective governance, lack of provider oversight, and failure to act on duty of candour, resulting in breaches of Regulations 12, 17 and 19.
Concerns (12)
criticalMedication management — “The management of medicines was not always safe. The systems in place to mitigate risks with the administration of medication were not robust.”
criticalMedication management — “One person's medicines were secondary dispensed... This practice was not risk assessed and there were no written procedures for staff to follow to mitigate possible risks.”
criticalCare planning — “People's needs and risks had not been adequately assessed and care plans had not been updated appropriately, when people's needs and visit preferences had changed.”
criticalRecord keeping — “Records relating to the length of time staff spent providing support to people, were also not accurate... visit records showed visits lasted less than 5 minutes.”
criticalGovernance — “The governance arrangements in place to audit the quality and safety of the service were not sufficient. The systems in place were poor and ineffective.”
criticalLeadership — “There was little evidence that the provider had oversight of the service... neither the manager or provider of the service were able to explain the failings of the service.”
criticalSafeguarding — “the provider had failed to ensure appropriate checks on the suitability of this person had been undertaken prior to appointment. This placed people at unnecessary risk.”
criticalOther — “The provider had failed to notify CQC of the local authority investigation into the recruitment and safeguarding concerns... did not demonstrate they had a clear understanding of their duty of candour responsibilities.”
moderateMissed or late visits — “People's visits times did not always correspond with the visit times they had agreed with the service. Visits were sometimes much later or earlier than agreed.”
moderateInfection control — “the frequency of staff testing did not comply with government guidance, in place at the time of the inspection.”
moderateCommunication with families — “there was however little evidence that any regular care reviews took place to ensure people's care continued to meet their needs”
minorStaffing levels — “the manager told us the service was currently experiencing staff shortages. A recruitment drive was underway.”
Strengths
· People and relatives said staff were kind, caring, supportive and patient
· People reported feeling safe and well looked after by staff
· Care staff recruited by the manager had been recruited safely with appropriate pre-employment checks
· Safeguarding, accidents and other incidents involving people using the service were properly recorded and investigated
· People said it was easy to get in touch with the office to speak to someone
Quality-Statement breakdown (8)
safe: Using medicines safelyInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staff; Working in partnership with othersRequires improvement