Date of assessment: 6 to 23 August 2024. We visited the office location on 8 and 14 August 2024. Right at Home Chippenham is a domiciliary care service that provides the regulated activity personal care to people in their own homes. We assessed 33 quality statements across safe, effective, caring, responsive and well-led key questions. At the time of this assessment, there were 60 people using the service. At our last inspection on 11 August 2021, we found improvements were needed in support and training for staff, consistency with visit timings, stability to the management approach and communication with office staff. This assessment was carried out to check if those improvements had been completed. We found the action needed to carry out the improvements had been taken and the service is now rated good in all key questions and overall. Staff received an induction when they started work and had been provided with regular updates on different areas such as moving and handling and safeguarding. Staff told us they were well supported and had regular supervision. There was an electronic care planning and staff rota system which people and relatives could access if they wanted to check visit times. Risks to people's safety were assessed and staff had guidance available. Care plans were regularly reviewed to make sure they were accurate. If needed staff contacted healthcare professionals to help meet people's health needs. There were 2 registered managers at the service who were supported by the provider. Governance systems helped to identify improvements and improve the safety of care delivery.
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Right at Home Chippenham received an overall rating of Requires Improvement at its first comprehensive inspection in August 2021, with failures centred on incomplete mandatory staff training (including only 60.7% MCA completion), absent supervision, late visits, and operating without a registered manager. Despite these shortfalls, the service demonstrated genuine strengths in medicines management, infection control, and compassionate care delivery, and had a credible action plan in place to address identified gaps.
Concerns (8)
criticalGovernance: “The service did not have a registered manager, which was a condition of their registration.”
criticalSafeguarding: “the provider had identified not all safeguarding incidents had been properly reported.”
moderateStaff training: “only 72% of staff had completed Basic Life Support training and 76.9% had completed Food Hygiene training. This did not ensure staff had the knowledge and skills to support people effectively.”
moderateSupervision / appraisal: “One-to-one meetings with their supervisor, for support and to reflect on their work, had not routinely occurred.”
moderateConsent / capacity: “records showed only 60.7% of staff had completed this. This did not ensure staff had the required understanding of consent and lawful decision making.”
moderateMissed or late visits: “visits were not always on time...if they were running late, the office did not always inform people...there had been 27 complaints this year. These were generally related to late visits.”
moderateCare planning: “Sending schedules of their visits to people was sporadic and not always accurate...care plans needed to be more person centred. The provider told us 'Care plans are ok, but we can improve.'”
moderateLeadership: “Staff told us there was a clear divide between the office, and those who provided people's support. They said communication was often poor.”
Strengths
· Medicines safely managed with electronic administration system and daily checks; 100% of people had no concerns about medicines support.
· Robust infection control including weekly COVID-19 staff testing and 100% of people confirming appropriate PPE use.
· People felt safe with staff; 100% felt staff supported them to keep safe and well at home.
· Staff treated people with kindness, compassion and respect; care reviewing website showed a score of 10 out of 10.
· People were involved in developing and signing their care plans.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
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 concernsRequires improvement
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staff; Working in partnership with othersGood
Right at Home Chippenham's first CQC inspection rated Safe as Requires Improvement due to incomplete risk assessments, missed visits, infection control lapses, and a delayed safeguarding notification, while Well-Led was rated Good for supportive leadership, a positive team culture, and effective governance systems. The overall service was inspected but not rated as only two of the five key questions were assessed.
Concerns (10)
criticalSafeguarding: “where two people had been involved in a safeguarding and were vulnerable to specific risks from this, there was not a risk assessment in place.”
moderateCare planning: “one person's falls risk assessment stated they had fallen in 2019. The care plan had been reviewed in October 2020 but did not include that the person had also fallen twice in 2020.”
moderateCare planning: “Another person who was at risk of choking did not have enough detail included on the measures staff should take if they had a choking incident.”
moderateMissed or late visits: “The majority of staff reported that there had been times where people had not received their visits due to miscommunication.”
moderateInfection control: “six relatives commented that at times during the year, they had seen staff remove or not wear their face masks.”
moderateGovernance: “In September 2020 one allegation of financial abuse notification was delayed in being submitted to CQC.”
moderateRecord keeping: “One staff did not have any employment references in place. It showed that attempts had been made but they had not managed to contact them.”
moderateStaff training: “some medicine administering procedures were not completed due to staff not having yet completed the correct training.”
minorCommunication with families: “There is no rota and no routine. If you ring up and ask for something it doesn't happen.”
minorRecord keeping: “although information had been recorded around incidents this was not in the incident log to show the actions taken following an event.”
Strengths
· Staff had the knowledge and confidence to identify safeguarding concerns and act on them to keep people safe.
· Service maintained staffing levels during the COVID-19 pandemic without agency staff or business continuity plan.
· All staff reported no issues obtaining PPE; management kept staff informed of changing pandemic guidance.
· Medicine administration records (MARs) were being completed appropriately and recently redesigned for clarity.
· Management promoted a no-blame culture around incidents and used them for team learning.