Carefocal was rated Requires Improvement overall at its first inspection, with breaches of Regulations 9, 12, 17 and 19 relating to person-centred care, safe care and treatment, good governance and recruitment. Risks, medicines, care planning, recruitment checks and oversight of staff punctuality were inadequate, though safeguarding, infection control and staff training were satisfactory.
Concerns (12)
criticalMedication management: “Medicines were not always safely managed. Medicine risk assessments and risk management plans were not always in place.”
criticalCare planning
: “Risks to people were not always identified and risk management plans or guidance for staff was not always in place in relation to choking, falls, medicines and moving and handling.”
criticalStaffing levels: “Both staff don't usually turn up at the same time, one is always late. So, my [relative] is moved by only one staff member which is not safe.”
criticalGovernance: “The provider's governance of the service was not effective or robust. There was a lack of oversight, leadership and governance at the service.”
criticalPerson-centred care: “People or their relatives were not involved in planning their care and support. Care plans were not reviewed regularly and were not signed by people or their relatives.”
criticalStaff competency: “The provider did not have a robust recruitment process and staff were not always recruited in line with this. Appropriate checks were not completed.”
moderateMissed or late visits: “The staff have been late frequently. I've been contacting the senior staff at the office and they just apologise, but nothing really changes.”
moderateLeadership: “The provider was not aware of the majority of the concerns we raised during the inspection.”
moderateConsent / capacity: “People who had a lasting power of attorney did not have these details recorded in their care plans.”
moderateRecord keeping: “People's care plans recorded contradictory information about their medicines... some people's care plans either did not list their current medicines or had a list of their medicines that was out of date.”
moderateCommunication with families: “As a relative, sometimes I'm kept in the dark as far as the visiting times and the staff don't let me know when they are going to be late.”
moderateEnd-of-life care: “People who had a 'Do Not Attempt Resuscitation' form (DNAR) in place, did not have information in their care plans about where in their home this could be located.”
Strengths
· Appropriate adult safeguarding procedures in place; staff completed safeguarding training and knew how to report concerns.
· People were protected from the risk of infection; staff had ample PPE and completed infection control training.
· Staff were up to date with mandatory training and supported through regular supervision.
· Accidents and incidents were appropriately recorded and investigated in a timely manner.
· Service worked in partnership with healthcare professionals including GPs and district nurses.
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Fit and proper persons employedRequires 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: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
well-led: Continuous learning and improving careRequires improvement
well-led: Managers and staff are clear about their roles, and understand quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement