Evolving Care Limited received a Requires Improvement rating following a focused inspection of Safe and Well-led domains, with multiple continuing breaches of Regulations 12, 17, and 18 covering unsafe medicines management, inadequate risk assessments, poor staffing governance, and failure to notify CQC of safeguarding incidents. Despite some improvements to auditing systems and positive feedback from people about care staff, the provider failed to make sufficient progress since the previous Requires Improvement rating in August 2021.
Concerns (14)
criticalMedication management: “Medicine records for as required medication lacked detail for people, eye drops and creams were not always effectively managed as well as risk assessments required for prescribed creams.”
criticalMedication management: “Training matrix record showed that the training course for medication administration was completed the same day as 18 other courses for much of the workforce.”
criticalSafeguarding: “Records held with the provider and the safeguarding referrals made to the local authority were not always reported by way of notification to CQC.”
criticalIncident learning: “A person's care plan and risk assessment were not updated after an incident that had occurred.”
criticalCare planning: “Risks had not been sufficiently assessed or mitigated and care plans were not always in place to guide staff on how to keep people safe.”
criticalStaff training: “Induction training was completed on the same day for a large percentage of staff, this was a total of 18 courses for 47 staff members out of 57.”
criticalGovernance: “The provider's system did not always effectively monitor the quality of care provided to drive improvements.”
criticalRecord keeping: “People's care records and risk assessments were not reviewed after an incident.”
moderateStaffing levels: “We found on two consecutive visits that the rotas were not complete for the following week, and this was corroborated by discussions with staff.”
moderateStaffing levels: “For some staff, we found excessively long shifts from early morning till later at night. This was evidenced by rotas and staff interviews.”
moderateSupervision / appraisal: “Staff did not have regular supervision or appraisals of their performance. Staff told us they could not recall the last time they spoke with the registered manager.”
moderateStaff competency: “Staff were not always recruited safely. We found that recruitment and induction processes were not robust.”
moderateMissed or late visits: “Reports of staff being late, frequent breakdown of staff vehicles and staff changes without informing the person or the family member.”
minorPerson-centred care: “The provider was unable to evidence annual survey engagement and feedback improvement plans, from people or their families.”
Strengths
· People told inspectors they felt safe whilst receiving care and many were complimentary about the standard of care.
· Improvements were made to quality systems and auditing processes since the last inspection, including enhanced monitoring of the care system on an on-call/out-of-hours basis.
· The provider invested in an electronic recording system to ensure calls are attended, medicines administered, and notes recorded and overseen by the office.
· Staff had access to PPE and infection control practices were satisfactory; people confirmed staff wore PPE and washed hands.
· People with a learning disability or autism were supported to have maximum choice and control in the least restrictive way.
Quality-Statement breakdown (9)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionGood
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmRequires improvement
safe: Learning lessons when things go wrongRequires improvement
well-led: Continuous learning and improving care; quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive, person-centred, open and inclusive cultureRequires improvement