At the time of our assessment, 3 people were receiving the regulated activity of personal care. Our assessment of the service started on 10 October 2024 and ended on 2 December 2024. Two inspectors carried out a visit to the agency’s office on 22 October 2024. During our assessment of the service, we looked at all the quality statements relating to all of the key questions. This assessment was to follow up on the findings of our previous assessment carried out on 28 February 2024. The service had made improvements and is no longer in breach of the regulations identified at our previous assessment. There was now a culture of learning from safety events. There were now effective risk assessments and care plans in place to guide staff about how to support people safely. Staff had received additional training about safeguarding adults from abuse and knew how to report concerns. Action had been taken to ensure all staff were appropriately trained and competent in their role. Systems to monitor and improve the quality and safety of the service had been introduced however more time is needed to ensure these are embedded and can be sustained over time. The provider has taken action to ensure they comply with the conditions of their registration. However, we have made a recommendation in relation to staff recruitment to ensure more robust procedures are followed. This service has been in Special Measures since 27 September 2024. The provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
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Date of assessment 28 February to 7 March 2024. We found 8 breaches of the legal regulations in relation to safeguarding, safe care and treatment, consent, person centred care, governance, staff training, failing to display their inspection rating and failing to comply with some of the conditions on their registration. The provider did not consistently protect people from abuse and improper treatment. Risks to people’s health and safety were not always assessed or managed. Medicines were not managed safely, and staff training was not appropriate and relevant to their role. People did not always have up to date and person-centred care plans to guide safe practice. People's capacity and ability to consent was not considered. Governance systems and audits were not effective in identifying or addressing areas for improvement. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.
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First inspection of this domiciliary care agency rated Inadequate overall and placed in special measures, with breaches of Regulations 9, 12, 13, 17, 18 and 19 covering person-centred care, safe care, safeguarding, governance, staffing and recruitment. Widespread failures were found in medicines management, risk assessment, training, supervision, MCA compliance, complaints handling and quality assurance.
Concerns (18)
criticalMedication management: “People's medicines were not managed safely to ensure they were not placed at risk.”
criticalStaff training: “Staff had not been provided with training to provide safe care.”
criticalSafeguarding: “The provider had not fully protected people from the risk of abuse and improper treatment.”
criticalStaff competency: “The staff member we spoke with was not aware of the risks to, or their care needs of, the person they supported.”
criticalSupervision / appraisal: “Staff did not receive regular supervision... One member of staff told us 'I've not had any supervisions since I started.'”
criticalCare planning: “No risk assessments or care plans had been completed for the person who was currently using the service”
criticalPerson-centred care: “People did not have person-centred care plans in place to help staff ensure they received personalised care.”
criticalGovernance: “The provider had failed to implement effective systems to assess, monitor and improve the service.”
criticalLeadership: “There were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalIncident learning: “We were not assured incidents and accidents involving people were consistently reported, recorded and investigated to promote learning and minimise the risk of reoccurrence.”
criticalComplaints handling: “The provider did not have a complaints policy or systems to record or respond to complaints.”
criticalConsent / capacity: “The provider was not working in line with the principles of the MCA. They were unable to evidence that people's rights under the MCA were being protected.”
criticalRecord keeping: “Records were of poor quality and did not include a complete, accurate and contemporaneous record of care provided.”
criticalOther: “The provider had not adhered to safe recruitment practices. This placed people at risk of being supported by unsuitable staff.”
moderateInfection control: “We were not assured staff were disposing of personal protective equipment (PPE) correctly.”
moderateCommunication with families: “Their relatives told us the provider had not involved them in care reviews, which meant they did not have appropriate opportunities to contribute towards decisions about their loved one's care.”
moderateCultural competency: “one person did not speak English. The provider had not given key information or documents, such as care plans, to the person in their own language.”
minorEnd-of-life care: “We saw no evidence in people's care plans that their wishes and preferences regarding their end-of-life care had been discussed with them”
Strengths
· Relatives reported staff treated their family members with kindness and compassion ('[Staff member] is very warm and friendly.')
· One relative stated 'Of all the carers we've had for [person's name], they are the best'
· Staff member reported feeling supported by and able to approach the provider ('[Provider] is very approachable and listens.')
· Care records were paper-based, held within a locked cabinet or people's own homes and only accessible to those that required access
Quality-Statement breakdown (17)
safe: Assessing risk, safety monitoring and management; learning lessons; preventing and controlling infectionInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Staff support: induction, training, skills and experienceInadequate
effective: Ensuring consent to care and treatment in line with law and guidanceInadequate
caring: Supporting people to express their views and be involved in making decisions about their care
Requires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesInadequate
responsive: Meeting people's communication needs (Accessible Information Standard)Inadequate
responsive: Improving care quality in response to complaints or concernsInadequate
responsive: End of life care and supportInadequate
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; continuous learningInadequate
well-led: Promoting a positive culture; duty of candourInadequate
well-led: Engaging and involving people, public and staff; working in partnership with othersInadequate