Domiciliary Support Team was rated Requires Improvement overall, with a breach of Regulation 17 (good governance) due to inaccurate care plans, gaps in medication and food/fluid records, and three safeguarding incidents not notified to CQC. The caring domain remained Good, with positive feedback about person-centred, dignified support.
Concerns (8)
critical
Governance
: “Recording shortfalls had not been identified through quality monitoring systems. We were not assured the provider had clear oversight of the service.”
criticalSafeguarding: “Three safeguarding referrals to the Local Authority had not been notified to CQC.”
moderateRecord keeping: “Accurate and contemporaneous records were not always maintained regarding people's care. This included risk assessments, medication records, food and fluid charts and communication plans.”
moderateCare planning: “Care plans provided staff with guidance on how to care for people. These were not always accurate or clear and needed updating.”
moderateMedication management: “we saw there were gaps in MARs when creams should have been applied. This had not been identified by the providers own audits.”
moderateOther: “People's food and fluid intake was not monitored and recorded effectively... There was a monthly weight chart, but it had not been completed as required.”
minorStaff competency: “Recruitment systems were in place, but needed to be more thorough when processing references, to ensure recruitment was safe.”
minorCommunication with families: “the person's communication plans did not accurately reflect the detail provided in formal assessments by the Local Authority and the NHS.”
Strengths
· Positive feedback from people and relatives about person-centred, kind and caring support
· Staff promoted equality and diversity and provided culturally appropriate care
· Effective infection prevention and control practices, including PPE use and testing
· Strong induction and training programme including the Care Certificate
· Service worked within the principles of the Mental Capacity Act
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Adapting service, design, decoration to meet people's needsGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
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
responsive: Meeting people's communication needsRequires improvement
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: End of life care and supportGood
responsive: Improving care quality in response to complaints or concernsGood
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 empoweringGood