ReadyCQC, a weekly field guide to CQC home-care regulation

criticalMedication management: “Entries made on MAR charts were not always consistent with the pair of staff who had signed the daily records of care which made it hard to establish who had provided medicine support.”
criticalRecord keeping: “Records of care delivered were not always accurate, complete or legible. This meant that in some circumstances we were unable to establish the full details of the care and support.”
criticalStaff training: “Staff had not received any practical training or competency assessment in moving and handling, despite using a range of equipment such as slide sheets, stand aids and hoists.”
criticalGovernance: “Systems to assess, monitor and improve the service were not sufficiently robust. Daily records from January 2021 which showed shortfalls had not been audited prior to our inspection visit.”
criticalSafeguarding: “Because of the issues with staff recruitment checks we did not feel completely assured about safeguarding. It was not always clear from records who had provided care and support.”
criticalStaff competency: “Safe recruitment practices were not consistently followed. Up-to-date DBS checks had not always been obtained when staff started work.”
criticalLeadership: “The registered office was based in Leeds, but most care packages were being delivered in Somerset. There was inadequate governance to manage this safely.”
moderateCare planning: “People did not have a medicine assessment detailing the exact nature of the support they required with their medicines. Care plans needed more detail.”
moderateIncident learning: “Care plans had not been updated following incidents with additional strategies to help guide staff. One incident response was not suitably robust.”
moderateEnd-of-life care: “No information on people's end of life arrangements were recorded. Care records did not contain end of life care plans.”
moderateInfection control: “A COVID-19 risk assessment was provided an hour and a half after requested, however it was not at all relevant to the service and mentioned another organisation throughout.”

Inspection report · 2023-04-01

Framework: KLOE · 14 pages · 88 KB · PDF

Good

safe: Goodeffective: Goodcaring: Goodresponsive: Goodwell-led: Requires improvement

My Horizon Care Ltd is rated Good overall, with four key questions rated Good and Well-led rated Requires Improvement following an August 2022 inspection of this 10-person domiciliary care agency in Leeds. The principal weakness was the failure of internal audits to identify gaps in medication administration records, though no medication errors were found and the service was no longer in breach of regulations identified at the previous inspection.

Concerns (4)

moderateMedication management: “some people's medication administration records (MAR's) had gaps and these coincided when people had been supported by their relatives with this area of their care”
moderateGovernance: “issues regarding the recording of medication and this had not been identified and addressed previously during the registered manager's internal audits”
moderateRecord keeping: “the MARs needed to be fully completed in-line with guidance to ensure records were kept accurate and any risks regarding missed medication mitigated”
minorPerson-centred care: “staff were, at times, task focused... 'they don't really chat to [them] otherwise'... 'they whizz in and out'”

Strengths

· People and relatives reported care was safe and concerns would be acted upon immediately
· Staff had good knowledge of safeguarding procedures and knew how to report concerns
· Safe recruitment practices were followed with appropriate checks in place
· Staff completed infection control training and used PPE appropriately
· People's needs were assessed before care began, including protected characteristics under the Equality Act 2010

Quality-Statement breakdown (19)

safe: Assessing risk, safety monitoring and management; Using medicines safely; Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier lives

Inspection report · 2022-02-17

Framework: KLOE · 14 pages · 85 KB · PDF

Not rated

safe: Not ratedeffective: Not ratedresponsive: Not ratedwell-led: Not rated

At this focused inspection the service was not providing regulated activity so could not be rated, but continued breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) were identified due to gaps in risk assessments, medicines planning and care records. Improvements were noted in staff recruitment and training, lifting previous breaches of Regulations 18 and 19.

Concerns (8)

criticalMedication management: “Planning and recording of medicines were not always consistent and in line with the provider's own medication policies and procedures.”
criticalCare planning: “The mock care records we reviewed did not always contain comprehensive risk assessments.”
criticalGovernance: “The quality assurance procedure in place had not been effective in identifying the issues found at this inspection and in driving the necessary improvements.”
criticalRecord keeping: “we continued to find examples of records related to people's care or medication not being complete and accurate, such as risk assessments and medication assessments.”
criticalLeadership: “The governance systems in place were not robust enough to demonstrate the registered manager had the appropriate oversight to safely manage the service.”
moderateIncident learning: “the registered manager did not show a good understanding of how they would use this information to look for trends and patterns and improve the provision of service.”
moderateConsent / capacity: “The registered manager's knowledge of the principles of the MCA was good, but less consistent in how to apply it.”
moderatePerson-centred care: “the person had specific communication needs and staff had to support them in a particular way, however, there wasn't a communication care plan in place.”

Strengths

· Improvements made in safe recruitment with criminal checks completed and recruitment policy in place; no longer in breach of Regulation 19.
· Staff had completed mandatory training including face-to-face training; no longer in breach of Regulation 18 (Staffing).
· Provider was aware of safeguarding responsibilities with policies, procedures and staff training for both adults and children safeguarding.
· Infection control policies and procedures in place with PPE available and staff aware of correct use.
· Staff reported the registered manager was approachable and fair, and felt comfortable giving feedback.

Quality-Statement breakdown (15)

safe: Assessing risk, safety monitoring and management; Using medicines safely; Learning lessons when things go wrongNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Supporting people to eat and drink enough; working with other agencies; accessing healthcareNot rated

Inspection reports (3)