First inspection of newly registered domiciliary care agency rated Requires Improvement overall, with concerns around risk assessments, medicines recording, person-centred care plans and ineffective governance audits. Staff were caring, well-trained and recruited safely, and the manager made immediate improvements following inspection feedback.
Concerns (9)
moderate
Care planning
: “Known risks to people had not always been assessed. For example, one person who was at risk when crossing a road, had no risk assessment or strategies recorded”
moderateMedication management: “When people had 'as required' (PRN) medicines prescribed, records were not always completed to evidence the reason the medicine was administered.”
moderateRecord keeping: “People's medicine administration records (MAR) were not consistently completed to evidence medicines were administered regularly. Some people had two separate MAR for the same medicines.”
moderatePerson-centred care: “some care plans had no personalised information recorded to support staff to understand how a person wanted to be supported or what actual tasks were required.”
moderateGovernance: “Audits completed on daily records and MAR were ineffective... the current process only checked five random files a month. This meant it could be up to eleven months before these records were audited again.”
moderateLeadership: “The service did not have a manager in place who was registered with CQC.”
moderateStaffing levels: “one person who required two staff to support them, told us, they generally only had one staff attend their calls.”
moderateIncident learning: “Records of seizure activity were not always documented correctly. Staff had not recorded the type or description of the seizure witnessed for one person who had experienced three recent seizures.”
minorCommunication with families: “eight people had recorded they were not 'kept informed of changes' or had not been 'contacted to see if they were happy.'”
Strengths
· Staff recruited safely with references and DBS checks completed before starting
· Staff received appropriate training including the Care Certificate and induction with shadow shifts
· People and relatives consistently positive about kind, caring and compassionate staff
· Staff respected privacy, dignity and promoted independence
· Appropriate use of PPE and adherence to COVID-19 government guidance
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot 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: Staff working with other agencies and supporting people to access healthcareNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot 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
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot 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