Surrey Children's Domiciliary Care Service was rated Requires Improvement overall due to two regulatory breaches: unsafe risk management (Regulation 12) with missing or insufficiently detailed risk assessments and behavioural management plans, and poor governance (Regulation 17) with ineffective quality monitoring systems and insecure storage of personal records. Strengths included safe medicines management, good safeguarding practices, consistent staffing, regular supervision, and positive caring relationships between staff and children and their families.
Concerns (7)
criticalCare planning: “Risk assessments were not always in place when a risk had been identified. Therefore staff did not always have information on how to manage and minimise risks to the children.”
criticalIncident learning: “Actions had not always been completed, leaving staff and child at risk of avoidable harm. We reviewed the child's risk assessment and this information had not been updated.”
criticalGovernance: “There were not robust systems in place to monitor, review and improve the quality of care and some records were not stored securely.”
criticalPerson-centred care: “For children who had behaviours that could challenge... There were no behavioural management plans in place to tell staff what the behaviours were, what the triggers may be.”
moderateRecord keeping: “Some personal records of children were stored out of the registered office to enable staff to access them and were not always stored securely.”
moderateCare planning: “Care plans did not have dates on as to when they had been written or when they had been reviewed. Therefore staff would not know how current or up to date the information was.”
moderateLeadership: “The service has a registered manager in post; they have not been in the service for over six months due to sickness... quality improvements had not been a priority.”
Strengths
· Medicines were administered, stored and managed safely with accurate MAR records and trained staff including emergency medicine competency assessments.
· Staff demonstrated good safeguarding knowledge and appropriate referrals were made to the local authority safeguarding team.
· Safe recruitment practices were in place including DBS checks, written references and photographs.
· Sufficient staffing levels were maintained and consistent staff were allocated to the same children.
· Staff received regular supervision every three months and annual appraisals.
Quality-Statement breakdown (17)
safe: Risk assessment and managementRequires improvement
safe: SafeguardingGood
safe: Medicines managementGood
safe: Staffing levels and recruitmentGood
effective: Consent and Mental Capacity ActGood
effective: Staff training and competencyGood
effective: Supervision and appraisalGood
effective: Nutrition and hydrationGood
caring: Relationships and person-centred approachGood
caring: Dignity, privacy and respectGood
caring: Involvement of children and familiesGood
responsive: Care planning and assessmentGood
responsive: Complaints handlingGood
responsive: Timeliness of visitsGood
well-led: Governance and quality assuranceRequires improvement
well-led: Record keeping and information governanceRequires improvement
Surrey Children's Domiciliary Care Service was rated Good across all five key questions at its November 2017 inspection, having successfully remediated breaches of Regulations 12 and 17 identified in July 2016. The service demonstrated strong personalised care, effective multi-agency working, robust governance systems and a well-supported, consistent workforce.
Strengths
· Risks routinely assessed with holistic, detailed plans; previous breach of Regulation 12 resolved with improved incident oversight system
· Medicines administered safely by trained staff with no gaps in MARs and competency assessed prior to administration
· Consistent, allocated support workers fostered strong relationships with children and families, with positive survey feedback throughout
· Care plans were detailed, personalised and produced in accessible pictorial formats; regularly reviewed and promptly updated
· Previous breach of Regulation 17 resolved; introduced secure electronic smartphones for field records and enhanced audit systems
Quality-Statement breakdown (21)
safe: Risk assessment and incident managementGood
safe: Safeguarding childrenGood
safe: Staffing and punctualityGood
safe: Medicines managementGood
safe: Infection controlGood
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Assessment and care planningGood
effective: Multi-agency and healthcare professional working
Good
effective: Consent and Mental Capacity ActGood
caring: Kindness, compassion and staff consistencyGood
caring: Involvement of children and families in careGood
caring: Privacy and dignityGood
responsive: Personalised care planningGood
responsive: Review and responsiveness to changing needsGood
responsive: End of life care preparednessGood
responsive: Complaints handlingGood
well-led: Governance, audits and quality monitoringGood
well-led: Record keeping and securityGood
well-led: Staff communication and supportGood
well-led: Vision, leadership and service developmentGood