Sensiway Care Services improved from Inadequate to Good across all five key questions following a follow-up inspection in January 2023, having remediated breaches of Regulations 12, 17, and 19 identified at the previous inspection in September 2022. The single person using the service received safe, person-centred care from a consistent, trained staff team with effective governance and quality assurance systems in place.
Strengths
· Pre-employment recruitment checks including references and DBS completed before staff worked with people
· Medicines managed safely with MAR charts completed and audits identifying errors; no medicines errors in recent months
· Staff trained in safeguarding, infection prevention and control, MCA, and end of life care
· Person received continuity of care from a consistent regular staff team
· Quality assurance systems and audits in place; provider addressed all breaches from previous inspection
Quality-Statement breakdown (24)
safe: Staffing and recruitmentGood
safe: Using medicines safely; Preventing and controlling infectionGood
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
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: 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: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
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 requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Continuous learning and improving care; Working in partnership with othersGood
Sensiway Care Services was rated Inadequate overall and placed in special measures, with breaches of Regulations 12, 17 and 19 leading to warning notices for unsafe care, poor governance, and inadequate recruitment. Significant shortfalls were found in staffing, infection control, medicines management, training, supervision, contingency planning and complaints handling, although staff knew people's preferences and safeguarding principles.
Concerns (12)
criticalStaffing levels: “There had not always been enough staff to meet people's needs... sufficient staff had not been available to provide two care staff to attend to this person's needs on all their required care calls.”
criticalGovernance: “Systems and processes were not operated effectively to assess, monitor, reduce risk and improve the quality and safety of services. Records were not always accessible, complete, contemporaneous, and accurate.”
criticalStaff competency: “Recruitment procedures were not established and operated effectively to ensure person's employed met the conditions and required recruitment checks.”
criticalInfection control: “Care staff were not wearing face masks or testing for COVID-19 in line with the latest government guidance... Infection risk assessments were not in place.”
criticalMedication management: “Medicines administration record (MAR) charts were not available... Older MAR charts had not always been filled in to say medicines had been offered.”
criticalStaff training: “Care staff had not been trained to have the skills and experience to reduce risks from COVID-19. The provider told us staff had not had training in COVID-19 other than being sent a booklet on it.”
criticalSupervision / appraisal: “There was no evidence care staff had supervision every three months. This meant staff development was not recorded and tracked.”
criticalLeadership: “Resources to run the service in the provider's absence were not available. The provider had not ensured there was an effective contingency plan in place for when they were absent.”
criticalRecord keeping: “The provider had not operated an effective system to ensure people's care records, including those for their medicines administration were accurate, complete and contemporaneous.”
moderateCare planning: “Risk assessments had not been kept under review... the risk assessment for one person at risk of falls had last been updated in 2021.”
moderateComplaints handling: “There was no system to record concerns and complaints and monitor them to ensure the provider's complaints policy was followed and effectively operating.”
moderateIncident learning: “Records did not provide enough detail to help identify learning when things went wrong.”
Strengths
· Staff understood how to identify potential signs of abuse and knew what actions to take to help safeguard people
· Staff understood people's dietary needs when they were involved in providing this care
· People's preferences were known and respected and people were involved in making decisions over their care
· People's independence was promoted and communication needs were met
· People were supported in ways to reduce the risk of social isolation
Quality-Statement breakdown (21)
safe: Staffing and recruitmentNot rated
safe: Prevention and control of infectionNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Systems to safeguard people from abuse; learning lessonsNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choicesNot rated
effective: Staff working with other agenciesNot rated
effective: Supporting people to eat and drink enoughNot rated
effective: Ensuring consent to care and treatmentNot rated
caring: Ensuring people are well treated and supportedNot rated
caring: Supporting people to express views and make decisionsNot rated
caring: Respecting privacy, dignity and independenceNot rated
responsive: Improving care quality in response to complaintsNot rated
responsive: Planning personalised careNot rated
responsive: Meeting people's communication needsNot rated
responsive: Supporting relationships and avoiding social isolationNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff understanding roles, quality, risks and regulatory requirementsNot rated
well-led: Promoting a positive person-centred culture; engaging people and staffNot rated
well-led: Duty of candour and working in partnership with othersNot rated