Homedotcare Limited improved from Requires Improvement to Good overall, with notable progress in medicines management, safeguarding, and leadership since the previous 2021 inspection. The Safe domain remained Requires Improvement due to 22% of care calls being late or short and inconsistent recruitment checks, resulting in two recommendations from the inspector.
Concerns (6)
moderate
Missed or late visits
: “78% of calls were delivered on time. 22% were more than 15 minutes late including 3% which were more than 45 minutes late. 15% of the calls were short calls.”
moderateRecord keeping: “One had no employment history recorded and no references on their file. The other only had one suitable reference.”
moderateCare planning: “One person's care notes included a choking risk identified but the importance of providing bite sized food had not been carried through to the care task section of the care plan.”
minorStaffing levels: “Calls requiring two care workers sometimes had staff arriving at different times.”
minorConsent / capacity: “Consent records were not always clear whether anyone had legal authority to make a decision on a person's behalf e.g. lasting power of attorney.”
minorEnd-of-life care: “Some people had end of life plans; others did not have sufficient information about their wishes at the end of their life.”
Strengths
· Medicines management had significantly improved since the last inspection, with a dedicated medicines champion appointed and people receiving medicines safely as prescribed.
· Strong safeguarding culture with staff booklets, good training and clear understanding of how to report concerns.
· Robust risk assessment and monitoring including a pressure ulcer booklet, falls register and individual fire risk assessments.
· Innovative person-centred practices including an activity library, food and household supplies bank, and birthday and Christmas gifts for isolated people.
· Staff felt well supported, with supervision, spot checks, orientation training, care certificate requirement, and a positive workplace culture.
Quality-Statement breakdown (22)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
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; Supporting people to live healthier lives and access healthcareGood
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: Meeting people's communication needsGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Supporting people to develop and maintain relationships; support to follow interests and activitiesGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles; Continuous learning and improving careGood
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 candourGood
well-led: Engaging and involving people, the public and staff; Working in partnership with othersGood
Homedotcare Limited was rated Requires Improvement at its first CQC inspection, with a regulatory breach under Regulation 12 due to unsafe medicines management including missing protocols for as-required medicines, anticoagulants, seizure management, and an outdated PEG administration record. The service performed well in effective, caring, and responsive domains, demonstrating strong person-centred care, cultural competency, and positive staff and service user feedback.
Concerns (6)
criticalMedication management: “guidance in the form of protocols or information in care plans was not in place to help staff give these medicines consistently.”
criticalMedication management: “For three people who were prescribed anticoagulants, guidance was not in place for staff in care plans to help staff monitor and manage their side effects.”
criticalMedication management: “One person's medicines were previously given via PEG...however their MAR and care plan was not updated. The records still outlined medicines to be given via PEG.”
criticalMedication management: “Four people who experienced seizures were prescribed medicines to prevent them. However, there was no information in the care plans for staff members on how to monitor or manage.”
moderateCare planning: “risks associated with some medical conditions such as diabetes and Parkinson's disease had not been assessed.”
moderateGovernance: “the provider had failed to effectively identify the medicine issues we identified during this inspection...and failed to identify some areas where risk assessments were required.”
Strengths
· People felt safe with care workers and reported punctual, consistent visit attendance with no missed calls.
· Comprehensive safeguarding training and clear staff understanding of abuse prevention procedures.
· Person-centred care plans with detailed individual preferences, cultural and dietary needs documented.
· Strong infection prevention and control measures including adequate PPE supply throughout the pandemic.
· Robust recruitment and DBS checking processes with sufficient staffing levels to meet people's needs.
Quality-Statement breakdown (23)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
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: Continuous learning and improving careRequires improvement
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: Engaging and involving people using the service, the public and staffGood