Heath Care Services improved from Requires Improvement to Good across all five key questions, having resolved prior breaches of Regulation 9 and Regulation 17 identified at the June 2022 inspection. The service demonstrated robust safeguarding, safe medicines management, person-centred care plans inclusive of equality and diversity needs, and effective governance and leadership.
Strengths
· Improved from Requires Improvement to Good overall, resolving prior breaches of Regulation 9 (Person-centred care) and Regulation 17 (Good governance)
· Medicines managed safely with trained, competency-assessed staff, management audits identifying errors and remedial action taken
· Care plans enhanced to include equality and diversity needs including sexuality, religion, culture and disability
· Robust safeguarding systems with staff trained in whistleblowing procedures and alerts raised in line with local authority recommendations
· PEEPs improved to include comprehensive evacuation plans for all floors following previous inspection gap
Quality-Statement breakdown (22)
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: Learning lessons when things go wrongGood
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: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and support; working with other agenciesGood
caring: Respecting and promoting people's privacy, dignity and independence; equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
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: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
Heath Care Services received an overall rating of Requires Improvement at its first inspection, with breaches of Regulation 9 (Person-centred care) and Regulation 17 (Good governance) identified due to incomplete equality and diversity assessments in pre-care and care planning processes and ineffective quality assurance systems. The service was rated Good for safety, with strengths in medicines management, safeguarding, staffing and infection control, but fell short in caring, effectiveness, responsiveness and leadership due to failure to address people's full equality characteristics.
Concerns (5)
criticalCare planning: “assessments did not cover all needs related to equality and diversity. For example, they did not cover needs related to ethnicity, gender or sexuality.”
criticalGovernance: “monitoring systems were not always effective...reviews had failed to identify shortfalls with care plans in relation to sexuality or the fire evacuation risk assessments”
criticalPerson-centred care: “The registered person had failed to carry out a comprehensive assessment of the needs and preferences for care of the service users. Specifically, they had failed to assess all relevant needs related to equality and diversity.”
moderateCultural competency: “pre-care assessments and care plans did not fully cover people's needs in relation to equality and diversity.”
moderateCommunication with families: “staff opened the door and came in without knocking first...one staff member said of an adult who used the service, '[Person] is like a small baby, so we need to treat them like a baby.'”
Strengths
· Medicines were managed safely with clear audit trails, regular medicines audits, and accurate stock balances.
· Sufficient staffing levels in place with robust recruitment practices including DBS checks and employment references.
· Effective safeguarding systems and staff trained in safeguarding adults responsibilities.
· Accidents and incidents were reviewed and measures put in place to prevent recurrence.
· Strong infection prevention and control measures in place.
Quality-Statement breakdown (23)
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
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Continuous learning and improving careRequires improvement
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: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires improvement