Independent Care and Support Limited was rated Requires Improvement overall following an April 2023 inspection, with breaches of Regulations 16, 17 and 19 identified relating to complaints handling, governance and staff recruitment. The service demonstrated kind, person-centred care from staff but failed to operate effective quality assurance systems, medicine management oversight or comprehensive staff competency checks.
Concerns (9)
criticalStaffing levels: “None of the 3 staff files we selected contained any references. This included staff who had previously worked in social care and for whom it is required suitable references are obtained.”
criticalGovernance: “The provider had failed to ensure there were adequate systems to assess, monitor and improve the quality and safety of service provided. This was breach of Regulation 17.”
criticalComplaints handling: “The provider had failed to operate an effective system for identifying, recording and responding to complaints. This was breach of Regulation 16.”
moderateMedication management: “Staff did not always observe them taking their medicines after they had given them to them. A person told us, 'Staff only watch me occasionally to make sure I have taken my tablets.'”
moderateStaff competency: “Neither were staff's practical moving and handling skills observed as part of spot checks to ensure staff were following guidance and safety protocols.”
moderateCare planning: “There was a lack of detailed guidance for staff about how to support people who used a catheter. Staff were not advised of the signs or symptoms of an infection so they knew when to seek medical advice.”
moderateStaff training: “Staff were provided with catheter care training at induction. However, there was no programme to refresh staff's knowledge through updated training or an assessment of their competency.”
moderateRecord keeping: “The auditing sheet to check that the provider's recruitment policy had been followed, had not been completed for any of these 3 staff.”
moderateIncident learning: “When concerns had been raised there was inadequate monitoring to ensure the chance of the same thing happening again had been minimised.”
Strengths
· People told us they felt safe and staff understood how to protect them from abuse; staff had undertaken safeguarding training and felt confident concerns would be actioned.
· Staff supported people to access healthcare services in a timely manner, making referrals to GPs and other health professionals as needed.
· People were treated with kindness, dignity and respect; the majority of people and relatives spoke favourably about staff and said they would recommend the service.
· Staff followed the principles of the Mental Capacity Act and supported people to make their own decisions.
· There were enough staff to meet people's needs and DBS checks had been obtained before staff worked unsupervised.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires 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
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
Independent Care and Support Limited received a Good rating across all five key questions at its announced inspection in October 2015, with 96 people receiving well-planned, person-centred homecare in the Medway area. No regulatory breaches were identified; the service demonstrated stable leadership, safe staffing practices, and effective systems for monitoring risk and quality.
Strengths
· People felt safe and spoke positively about staff being caring, compassionate and reliable
· Robust recruitment processes including DBS checks, references and identity verification
· Medicines administered safely with MAR sheets, spot checks and staff training
· Risk assessments completed as a priority when people started using the service
· Staff received comprehensive induction, regular supervision, appraisal and up-to-date training
Independent Care and Support Limited received an overall Good rating across all five key questions at its December 2017 announced inspection, maintaining the standard set at its previous 2015 inspection. The service demonstrated consistent strengths in safeguarding, medicines management, person-centred care planning, staff training and governance, with only a minor observation about outdated Care Act 2014 terminology in some policies.
Concerns (1)
minorRecord keeping: “we noted that, in places they needed to refer to the terminology used in new Care Act 2014”
Strengths
· People consistently felt safe and spoke positively about staff competence, kindness and professionalism
· Robust safeguarding policy with staff trained to recognise and report abuse; one safeguarding incident appropriately reported and investigated
· Medicines managed safely with up-to-date MAR sheets, regular audits and spot-checks by the registered manager
· Sufficient staffing levels maintained with emergency backup systems to ensure continuity of care
· Monthly supervisions, annual appraisals, Care Certificate induction and regular training kept staff skills current