RT-Care Solution Limited's Main Office remained in breach of Regulations 12 and 17 at this focused inspection, with ongoing failures in medicines administration recording, risk assessment accuracy, and governance audit effectiveness. Some improvements were noted since the previous Inadequate rating, including safe recruitment practices and a positive, open culture, but systemic oversight weaknesses continued to place people at risk of harm.
Concerns (7)
criticalMedication management: “Medicine Administration Records (MARs) were not always completed which did not provide assurances people always received the medicines they were prescribed.”
critical
Care planning
: “Some people did not have risk assessments in place for specific health conditions such as Parkinson's Disease and Dementia.”
criticalGovernance: “Audits were completed but not always accurately which meant concerns and issues were not identified in a timely manner.”
moderateRecord keeping: “Accidents and incidents were kept in two different places which meant the monitoring audit completed did not contain all incidents that had occurred.”
moderateCare planning: “Some care plans were not always reflective of people's needs...discrepancies in information recorded around people's care needs, to what staff were providing.”
moderateConsent / capacity: “Mental capacity assessments had not been completed for people...we could not assess if good practice was fully embedded at the service.”
minorIncident learning: “There was a lack of notifications submitted which meant full assurances around embedded practice was not obtained during this inspection.”
Strengths
· Staff received training including health-specific areas such as Diabetes, Learning Disabilities and Autism, and catheter care.
· Staff completed inductions and received supervision every 3 months, which staff found supportive.
· Pre-employment checks including DBS were completed; provider no longer in breach of Regulation 19.
· Staff were described as highly passionate, going above and beyond, and people felt safe and happy with care.
· Open culture: people and staff felt able to raise concerns with an approachable registered manager.
Quality-Statement breakdown (16)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires 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; supporting people to live healthier lives and access healthcareGood
well-led: Managers and staff being clear about their roles; understanding 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 candourRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
RT-Care Solution Limited (Main Office) was rated Inadequate overall at its first inspection in June–July 2022, with breaches of Regulations 12, 17 and 19 resulting in conditions being imposed on its registration and placement in special measures. Widespread failures in medicines management, risk assessment, safe recruitment, safeguarding reporting and governance placed people at significant risk of harm.
Concerns (13)
criticalMedication management: “Medicine records did not contain accurate information. We saw one person's medicine record had been signed for by the same staff member for the whole month. However...the staff member had not provided care.”
criticalSafeguarding: “As a result of our inspection, we made three referrals to the local safeguarding board. The provider's systems...had not followed local safeguarding protocols.”
criticalGovernance: “No quality audits had been completed to ensure care was safe and effective...A lack of quality oversight meant the provider had failed to monitor and improve the quality and safety.”
criticalStaff training: “Staff had limited knowledge on how to meet some people's care needs...the provider could not evidence that this training had been completed.”
criticalCare planning: “Care plans were often generic and often contained information regarding other people. This meant that new staff would have difficulty delivering personalised care.”
criticalIncident learning: “The provider did not have a system to record accidents and incidents and no system to monitor and review for trends and to learn lessons when things had gone wrong.”
criticalLeadership: “The registered manager and nominated individual did not have clear oversight of the service. They had not identified the shortfalls we found on this inspection.”
moderateStaff competency: “The provider failed to complete competency checks for staff to ensure staff knowledge and practice was in line with current standards.”
moderateRecord keeping: “Staff did not keep clear records of the actual times spent with people so the provider could not demonstrate people received their care visits in a timely manner.”
moderateConsent / capacity: “One person's mental capacity assessment...was not for a specific decision and referenced decisions relating to multiple areas...also contained contradictory information.”
moderatePerson-centred care: “People's individual likes and preferences were not always recorded in their care plans and associated risk assessments. This meant new staff would be unclear on how best to support people.”
moderateSupervision / appraisal: “The registered manager failed to complete staff supervision and carry out competency checks in a timely manner. Staff were unclear about how they were performing within their role.”
minorInfection control: “We were not assured that the provider's infection prevention and control policy was up to date. The isolation information contained within it has been replaced by alternative guidance.”
Strengths
· Relatives provided positive feedback, describing staff as 'very friendly, very nice, very caring, trustworthy, efficient'
· The registered manager demonstrated awareness of equality, diversity and religious beliefs in care delivery
· Staff used PPE effectively and safely; the provider was accessing COVID-19 testing for staff
· The registered manager liaised with other professionals such as district nurses, social workers, and the crisis team
· The registered manager promoted dignity by matching staff gender preferences for personal care
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people; Learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies; Supporting people to live healthier livesGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Continuous learning and improving care; duty of candourInadequate
well-led: Working in partnership with othersInadequate
well-led: Engaging and involving people using the service, the public and staffRequires improvement