First inspection of a small domiciliary care service rated Requires Improvement overall, with breaches of Regulation 12 (safe care and treatment) for COVID-19 risk and infection control failings and Regulation 19 (fit and proper persons employed) for inadequate recruitment checks. Effective, caring and responsive domains were rated Good, but governance systems failed to identify the recruitment and risk assessment shortfalls.
Concerns (6)
criticalStaff competency: “The provider did not establish and operate safe recruitment procedures as they had not gathered sufficient information about candidates before they were employed.”
criticalInfection control: “The provider was not doing all they could to prevent and control infections as staff were not carrying out regular COVID-19 tests according to current government guidelines.”
moderateRecord keeping: “We were unable to review one member of staff's recruitment file as we were informed the file had been mislaid during the recent office move.”
moderateGovernance: “There were quality assurance processes in place but these were not always effective as they had not identified the issues with risk assessments and recruitment checks that we found.”
moderateCare planning: “the provider had also not assessed the risk of COVID-19 for people receiving care or staff.”
minorEnd-of-life care: “The service was not providing end of life care and support at the time of our inspection. People had not been consulted about whether they had any end of life preferences.”
Strengths
· People received their care visits as planned with sufficient staff and on time
· Staff received induction, training and ongoing support to fulfil their role
· People were treated with dignity, respect and kindness by regular care workers who knew them well
· Cultural and religious needs were assessed and met
· Care delivered in line with the principles of the Mental Capacity Act
Quality-Statement breakdown (22)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and management; Preventing and controlling infectionRequires improvement
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills, and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity, and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
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: Engaging and involving people using the service, the public and staffNot rated
well-led: Duty of candourNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Working in partnership with othersNot rated