Starry Care UK Limited improved from Requires Improvement to Good overall, with Safe and Well-led both rated Good following resolution of a prior Regulation 17 breach. The service demonstrated safe care delivery, effective governance improvements, and a supportive staff culture, with effective and caring key questions carried forward from the previous inspection.
Strengths
· People felt safe with carers and risk assessments were in place and reviewed regularly as needs changed.
· Support visits took place on time, staff completed all tasks and communicated proactively if running late.
· Medicines were managed safely using an electronic system with paper backup, staff received e-learning and practical competency assessments.
· Staff were recruited safely with DBS checks and references; sufficient staffing levels were maintained.
· Infection control measures were in place including PPE, with spot checks by management and immediate follow-up of concerns.
Quality-Statement breakdown (12)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Ensuring consent to care and treatment in line with law and guidanceGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Continuous learning and improving careGood
Starry Care, a small domiciliary care agency in Milton Keynes, was rated Requires Improvement overall at its first inspection in January 2020, with breaches of Regulation 17 (Good Governance) due to inadequate quality monitoring systems, incomplete medicine records, and lack of documented supervision. Care delivery was found to be caring, effective and responsive, with positive feedback from the one family member using the service at the time of inspection.
Concerns (7)
criticalGovernance: “The provider did not ensure systems and processes to assess, monitor and improve the quality of the service were implemented.”
moderateMedication management: “Records held about the person did not contain information about the medicines they were prescribed...care plan stated the person managed and administered their own medicine, however staff were responsible for the administration of some medicines.”
moderateCare planning: “Inconsistences in the care plan and delivery of care had not been identified. The care plan stated staff were not required to support with medicine. However, staff did administer eye drops.”
moderateSupervision / appraisal: “There were no records to evidence what had been observed or whether the member of staff was competent in their role...A system was not in place to evidence supervisions were scheduled.”
moderateStaff competency: “The provider had not implemented a system to record and plan the ongoing assessment and monitoring of staff's competence, through supervision and appraisal.”
moderateRecord keeping: “There was no documentary evidence to support the meeting had taken place, the issues discussed or its outcome...no records kept capturing their views or observations.”
minorStaffing levels: “Staff's employment history was not fully documented, and references provided by previous employers did not detail the role of the person who had provided the reference.”
Strengths
· Family members spoke positively of the caring approach of staff and described staff as friends due to positive relationships developed.
· Staff had undertaken training in safeguarding procedures and knew what action to take to protect people from harm and abuse.
· The director regularly visited people at their home and contacted them by telephone to seek their views about the service.
· Staff wore personal protective equipment such as gloves and aprons when providing personal care, supporting infection control.
· Care plans were written with the involvement of the person receiving care, ensuring their wishes and expectations were understood.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
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 lawGood
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 to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture; managers and staff being clear about roles; engaging people using the serviceRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Continuous learning and improving careGood