Kare Plus Oxford was rated Requires Improvement following a focused inspection triggered by concerns about management oversight and staffing, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) identified. Key failures included inadequate risk assessment, absent PRN medication protocols, staff working without completed recruitment checks, ineffective auditing systems, and a failure to refer a safeguarding concern to the local authority.
Concerns (12)
criticalCare planning: “Risks had not always been assessed or mitigating strategies implemented. In all 3 people's care records we reviewed we found risks surrounding people's health conditions and medicines had not been fully assessed.”
criticalSafeguarding: “Records evidenced that one person had told staff of a potential safeguarding concern. Managers had not informed the local safeguarding team.”
criticalStaff training: “Staff did not have training on supporting people living with dementia or diabetes, and some staff had not completed their training before supporting people.”
criticalGovernance: “Audits had not been completed regularly and had not identified the issues we found with missing or incorrect information in care planning documents.”
criticalStaff competency: “We found no references had been sought for 1 staff member who was working with people... Another staff member had not had an updated DBS check.”
moderateRecord keeping: “Records of injuries were not fully recorded. We found no information recorded regarding position, size, colour or shape of injury.”
moderateIncident learning: “Incidents and accidents recorded did not always have an investigation completed to identify any risks, trends or patterns.”
moderateMedication management: “When people had 'as required' (PRN) medicine prescribed, there were no PRN protocols in place to advise staff on when the medicine should be administered.”
moderateConsent / capacity: “The manager had not identified when a relative who did not have the legal power to do so was signing consent for people.”
moderateSupervision / appraisal: “Not all staff had received a spot check to check if staff were working in a safe, person-centred way or if they were following policies and procedures.”
minorStaffing levels: “Staff do not always turn up on time due to not having enough travel time between visits.”
minorCommunication with families: “One person said, 'I feel there is a lack of organisation and communication between the office, manager, the care staff and me.'”
Strengths
· Staff were described as kind, caring and lovely by people and relatives.
· Staff received safeguarding training and were confident raising concerns internally and externally.
· Staff wore appropriate PPE and received infection prevention and control training.
· Relatives were kept up to date on changes in people's needs, incidents and accidents.
· Staff liaised with healthcare professionals to coordinate better care.
Quality-Statement breakdown (10)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
Kare Plus Oxford was rated Good overall following a targeted inspection prompted by concerns about care quality, recruitment checks, staffing, medicines and infection control. Inspectors found the service safe, responsive and well-led, with only minor issues around PRN protocols and weekend staffing pressures.
Concerns (3)
minorMedication management: “we could not find protocols to ensure the safe administration of 'as required' medicine (PRN). We informed the manager who said they would take action to resolve these concerns.”
minorStaffing levels: “I think the staffing levels seem to fall short at the weekends where staff feel pushed, but care calls are met.”
minorRecord keeping: “some of the documents we requested were hard to find. The manager told us, 'I've not been here that long, but it was clear to me I need to reorganise the office.'”
Strengths
· People felt safe and staff were trained in safeguarding with clear reporting routes
· Robust recruitment processes including DBS checks and references
· Person-centred care plans regularly reviewed with involvement of people and relatives
· Effective use of PPE and infection control practices
· Supportive and approachable new manager driving improvements
Quality-Statement breakdown (15)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood