Ryan's domiciliary care agency was rated Requires Improvement overall at its first inspection, with breaches of Regulation 17 (Good governance) due to ineffective audits, inconsistent medicines recording, gaps in risk mitigation records and care plans containing incorrect information. People felt safe and well cared for, with caring and responsive domains rated Good and the registered manager described as open and committed to improvement.
Concerns (10)
criticalMedication management: “Recording on medicine administration records (MAR) had not always been completed appropriately... codes used for when a medicine was not given were not always correct and we found multiple missed signatures.”
criticalMedication management: “Prescribed thickener... had not been consistently signed as administered or documented... This put people at risk of not receiving their medicines as prescribed.”
criticalRecord keeping: “Not all mitigating strategies for known risks were recorded... staff had not consistently recorded how much thickener was used, the water temperature before supporting a person with bathing or urine output”
criticalGovernance: “The provider failed to ensure adequate systems and processes were in place to assess, monitor and improve the quality and safety of the care provided. This was a breach of regulation 17”
criticalGovernance: “Audits completed on medicines were not effective. The audits completed had not identified the issues we found with missing signatures and recording of medicines.”
moderateCare planning: “Some care plans held incorrect information... one person's care plan stated they required thickener in fluids but refused to have thickener. However, this was incorrect”
moderateConsent / capacity: “records did not always document the questions asked or answers received to detail the decisions made regarding the person's capacity.”
moderateIncident learning: “after one significant event the duty of candour had not been completed.”
minorSupervision / appraisal: “Not all staff felt they received regular supervisions.”
minorCommunication with families: “some relatives felt communication could be improved between staff and relatives.”
Strengths
· People were protected from the risk of abuse; staff were trained and understood safeguarding procedures
· Safe recruitment practices including DBS checks and references
· Staff wore appropriate PPE and received infection prevention and control training
· People supported to access healthcare services with referrals to specialists (SALT, epilepsy, assistive technology)
· Staff treated people with kindness, dignity and respect; people felt their privacy was respected
Quality-Statement breakdown (22)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff working with other agencies; supporting people to access healthcare servicesGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceGood
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
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationshipsGood
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, understanding quality performance, risks and regulatory requirements; duty of candourRequires improvement
well-led: Promoting a positive culture; engaging and involving people, the public and staffGood
well-led: Continuous learning and improving care; working in partnership with othersGood