ReadyCQC, a weekly field guide to CQC home-care regulation

Inspection report · 2021-10-30

Framework: KLOE · 16 pages · 95 KB · PDF

Inadequate

safe: Inadequateeffective: Requires improvementcaring: Requires improvementresponsive: Requires improvementwell-led: Inadequate

Delta Care – Trafford, a domiciliary care agency serving 58 adults, was rated Inadequate overall on its first inspection, with warning notices issued for breaches of Regulations 9, 12 and 17, and placed into special measures. Pervasive failures included chronic late and missed visits, unsafe medicines administration, poor staff continuity, ineffective governance, and a systemic lack of communication with people using the service and their families.

Concerns (12)

criticalMissed or late visits: “People and relatives told us staff did not always attend the planned call for care and support at the agreed time and some calls could be an hour early or two hours late.”
criticalMedication management: “People were not receiving some of their medicines at appropriate intervals due to the calls being early or late... missed signatures which meant we could not be assured people had received their medicines as prescribed.”
criticalSafeguarding: “Two people told us, staff had let themselves in via the key safe and wandered around their property without permission. A third person told us, a staff member arrived one evening with a 'friend'.”
criticalGovernance: “Audits to monitor and improve the service had not highlighted the concerns with late and early calls and that staff were not staying the allocated time of the visit.”
criticalPerson-centred care: “For one person, for 69 visits from 124, they did not receive an adequate allocation of support from the visiting staff member.”
criticalLeadership: “No action had been taken to ensure people received personal care and support from staff in a timely manner... Systems to manage the quality of the service were ineffective.”
moderateCare planning: “We saw for two people, their needs had changed, and the paper care plan no longer reflected this. We reviewed the information on the app, and the information did not reflect current needs.”
moderateCommunication with families: “People overwhelmingly told us, they had to ring the office and find out why their call was late and sometimes there was no response.”
moderateComplaints handling: “People did not always know who to raise a complaint with or did not complain as they did not want to get staff into trouble.”
moderateInfection control: “We observed a staff member administer medicines, serve food and then assist with redressing a person wearing the same gloves.”
moderateRecord keeping: “Staff were not always logging in and out of calls. For one person who had received 124 calls over October 2019, the call had not been logged on 24 occasions.”
minorStaff training: “Some staff told us there was a lack of training around pressure care which included how to put on compression stockings or specialist footwear.”

Strengths

· Staff received training to administer medicines and were competency checked before supporting people with medicines.
· Staff received appropriate pre-employment checks prior to commencing employment.
· Risk assessments for people's properties were robust to ensure safety for person and staff.
· Accidents and incidents were recorded and analysed to prevent future occurrences.
· People received appropriate assessments of their capacity in line with the Mental Capacity Act 2005.

Quality-Statement breakdown (15)

safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidance

Inspection report · 2020-09-20

Framework: KLOE · 12 pages · 85 KB · PDF

Requires improvement

safe: Requires improvementcaring: Goodwell-led: Requires improvement

Delta Care – Trafford demonstrated substantial improvement since its previous Inadequate rating, exiting Special Measures with no remaining regulatory breaches across Safe, Caring, and Well-led domains. Residual gaps in recruitment record-keeping and an out-of-date care plan/audit process kept the overall and two key question ratings at Requires Improvement.

Concerns (3)

moderateRecord keeping: “two of the three staff recruitment files we viewed, did not contain the applicant's full employment history and any gaps in employment had not been explored. Three of the files did not have health declarations.”
moderateGovernance: “one of the care plans and accompanying risk assessment we reviewed was out of date. The registered manager had completed both the care plan and the audits of the care plans.”
minorCare planning: “One risk assessment was out of date. The risk issue identified was no longer current and the care plan needed to reflect this.”

Strengths

· Significant improvements in medication administration since previous inspection; medicines now given at correct times with updated smartphone app and staff competency checks.
· Visit punctuality improved markedly; staff have designated geographical areas and a live monitoring system flags shortfalls immediately.
· People now receive support from regular carers, improving consistency and feelings of safety.
· Monthly surveys introduced post-inspection with overwhelmingly positive feedback and rapid response to any concerns.
· Staff feel valued and supported; registered manager fosters open, honest culture and praises staff regularly.

Quality-Statement breakdown (13)

safe: Using medicines safelyGood
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their care

Delta Care - Trafford

Inspection reports (3)