First inspection of this domiciliary care agency rated Requires Improvement overall, with a breach of Regulation 17 (good governance) due to weak quality monitoring affecting recruitment, medicines, induction and infection control oversight. Responsive care was rated Good, but dignity concerns, gaps in MAR records, and inconsistent care planning required improvement.
Concerns (13)
critical
Governance
— “The provider failed to ensure effective and robust quality monitoring systems were in place to ensure they had good oversight of the service.”
criticalPerson-centred care — “People did not always have their dignity upheld... One relative commented, '[Person] felt completely degraded, it was shocking.'”
moderateMedication management — “Medicine administration records (MAR) contained gaps where staff had not signed to evidence they had administered prescribed medicines.”
moderateMedication management — “When people had 'as required' (PRN) medicines prescribed, records were not always completed to evidence the reason the medicine was administered.”
moderateInfection control — “There were poor hygiene practices in place relating to the disposal of waste products and this put people at risk of cross contamination.”
moderateStaff training — “Not all staff had received training in safeguarding”
moderateStaff training — “staff were still waiting to receive the appropriate training before they could use the pieces of equipment.”
moderateRecord keeping — “Some recruitment records required improvement to clearly show identification checks had been verified and documents relating to recruitment had been signed by the employee.”
moderateRecord keeping — “records relating to the induction were not in place for all staff. For example, some staff had induction and shadow shift check lists, some staff had no records relating to their induction.”
moderateCare planning — “Not all care plans contained person-centred information within them. For example, some care plans had limited personalised information recorded”
moderateConsent / capacity — “mental capacity assessments and best interest decisions required more detail to show how judgements were reached.”
moderateLeadership — “People and their relatives had not been asked to formally feedback on the quality of care people received.”
minorCommunication with families — “sometimes you do not know who is going to come, we aren't always told about changes.”
Strengths
· Sufficient staff to safely meet people's needs and staff took part in regular COVID-19 testing
· Staff worked closely with healthcare professionals such as occupational therapists and physiotherapists
· Person-centred care delivery with staff who knew people's individual needs and preferences
· Effective complaints handling systems with concerns investigated to satisfaction
· Care plans included communication needs and information could be produced in accessible formats
Quality-Statement breakdown (21)
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuse; learning lessons when things go wrongNot rated
safe: Assessing risk, safety monitoring and managementNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferences; end of life care and supportNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Continuous learning and improving care; Working in partnership with othersNot rated