Focused inspection of a domiciliary care agency supporting 80 people identified breaches of Regulation 12 (safe care) and Regulation 17 (good governance) due to inadequate risk assessments, weak medicines management protocols and ineffective quality assurance. The overall rating dropped from Good to Requires Improvement, although staff were caring, well-trained on safeguarding and infection control, and management was open to making improvements.
Concerns (9)
criticalCare planning: “Where these protocols identified risk to people, these risks had not always been assessed and appropriate risk management plans were not in place for people who may experience falls, epilepsy, swallowing difficulties”
criticalMedication management: “people were at risk of not receiving their regular and as required medicines and medicinal creams as prescribed as clear medicine management plans and protocols were not in place”
criticalMedication management: “Medicines risk assessments were not in place which may put some people at risk of avoidable harm; for example, there was no clear risk assessment in place for people who are at increased risk when taking anticoagulants”
criticalGovernance: “effective systems had not been established to assess and monitor the service being provided. Complete and contemporaneous records were not always in place”
moderateRecord keeping: “The documentation of medicines and the auditing of these records to ensure the safe management of people's medicines required improvement.”
moderateConsent / capacity: “People's consent to the management of their risks and supports needs had not always been obtained by the provider in line with the principles of the Mental Capacity Act (2005).”
moderateStaff competency: “Records relating to the pre-employments checks that had been completed required some more detail to support the registered managers decision to employ them.”
moderateOther: “Staff may be at risk as they did not always have access to information about any risks of lone working and any associated environmental risks”
minorCommunication with families: “Some people felt communication could improve if staff were running late.”
Strengths
· People were supported by small consistent staff teams who were familiar with their needs
· Staff were kind and provided care which was personalised and responsive to people's needs
· Staff had received appropriate safeguarding training and understood their responsibilities to report concerns and whistle-blow
· Staff wore appropriate PPE and were trained in infection control and COVID-19 practices
· Open door policy from managers; staff felt supported and listened to during COVID-19 lockdown
Quality-Statement breakdown (8)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; duty of candour; continuous learning and improving careGood
well-led: Engaging and involving people using the service, the public and staff; working in partnership with othersGood