Elite Domiciliary Care PVT Ltd was rated Good overall following a comprehensive inspection on 27 September 2022, with Safe, Effective, Caring and Responsive all rated Good, but Well-Led remaining at Requires Improvement due to insufficient medicines audits, inconsistent staff access to risk assessments, and failure to display the CQC rating on the provider's website.
Concerns (4)
moderate
Governance
: “Medicines audits were not being completed at the time of the inspection. The manager told us the electronic system flagged any issues which they would then address.”
moderateRecord keeping: “Not all risk assessments were available to staff on the app and some information was in people's paper folders in their homes. Not all staff were aware of accessing the paper folders.”
minorGovernance: “The CQC rating was not displayed on the provider's website in line with regulations. The provider had been made aware and told us they were addressing this; however, this had not been corrected.”
minorStaffing levels: “We received mixed feedback about the continuity of staff attending people's calls... One relative told us, 'It's a jumble at the moment with staff leaving. It's different ones coming'.”
Strengths
· People were kept safe from abuse and staff understood safeguarding policies and procedures.
· Medicines were safely managed with trained staff and electronic MAR recording.
· Staff were safely recruited with DBS checks and references from previous employers.
· Care plans were detailed, personalised and included people's preferences and risk assessments.
· Accidents and incidents were recorded with lessons learned and improvements made.
Quality-Statement breakdown (18)
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law; Supporting people to eat and drink enoughGood
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; 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: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
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: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; Engaging and involving people; Working in partnership with othersGood
Elite Domiciliary Care PVT Ltd received a Requires Improvement rating following a focused inspection of Safe and Well-Led, deteriorating from Good at the previous inspection. Key failures centred on unsafe medication management (absent PRN protocols, unsigned MAR charts), incomplete staff recruitment records, and governance audits that failed to detect these issues.
Concerns (7)
criticalMedication management: “Where people were prescribed 'as required' (PRN) medication, the service did not always have protocols or guidance in place for prescribed medicines or creams”
criticalCare planning: “For one person who was prescribed time specific medication, the guidance in their care file was not detailed enough.”
moderateMedication management: “Staff had not always signed the associated medicine administration record (MAR) when people had been administered their medicines”
moderateRecord keeping: “The registered manager could not always evidence they had taken a full employment history of some staff.”
moderateGovernance: “These audits did not highlight some of the issues that we found during inspection...people did not have PRN protocols in place”
moderateIncident learning: “The registered manager had highlighted that accidents and incidents had not previously been recorded or reviewed.”
minorMissed or late visits: “The morning and evening calls are time specific, the [staff] are often late, I have called the office and they blame the [staff]”
Strengths
· Effective safeguarding systems in place; all recorded safeguarding concerns reported to appropriate authorities
· Staff demonstrated good understanding of safeguarding procedures and infection prevention control
· PPE used effectively and safely; provider met shielding and social distancing rules
· Personalised risk assessments in place for mobility and moving and handling support
· Positive staff culture; staff spoke highly of support received from the registered manager
Quality-Statement breakdown (11)
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
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
Good
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood