The assessment took place from 24 October 2024 to 18 November 2024. It was undertaken in response to concerns about the service. Kaplan Care is a domiciliary care service providing personal care to people living in their own homes. At the time of assessment, the service was providing personal care to four people. We announced the site visit to the provider 48 hours’ beforehand; this was because we needed to be sure the provider would be available to support this inspection. During this assessment, we found three breaches of the legal regulations in relation to safe care and treatment, complaints, and governance. We have asked the provider for an action plan in response to the concerns found at this assessment. Risks to people were not properly assessed and management plans were not always detailed to provide information for staff to keep people safe. Staff were not supported to be effective in their roles. The provider had not taken steps to improve staff experience of the service. Staff did not always follow the procedures in place to report safeguarding concerns, incidents and accidents and when things went wrong. There were no systems in place to discuss and share lessons from incidents and accidents; and when things went wrong. Records of concerns and complaints made about the service were not maintained. Governance systems were not always effective. The quality of the service was not effectively assessed and monitored. The leadership and management of the service was ineffective. People told us staff were kind and caring. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff encouraged people to increase their independence if appropriate. People told us they felt safe with staff.
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Kaplan Care's first inspection found breaches in person-centred care, safe care and treatment, staffing/training and good governance, with poor risk assessment, medicines management, recruitment records and absent audits. Despite kind staff and positive feedback from people and relatives, all five key questions were rated Requires Improvement.
Concerns (9)
criticalMedication management: “Medicines were not always well managed. Medicines records were poor, medicines administration records (MAR) were not always complete, accurate and clear.”
criticalStaff competency: “Staff confirmed that they had not been checked by management team to ensure they were competent to administer medicines following medicines e-learning training.”
criticalCare planning: “Care plans were inconsistent across the service. Some lacked important information individual to the person. Two people did not have a care plan at all.”
criticalStaff training: “The training records did not evidence that staff had completed additional training to meet people's assessed needs such as catheter care, diabetes, skin integrity, choking and dysphagia.”
criticalGovernance: “The systems in place to audit the quality of the service were not embedded, robust or sufficient to alert the provider of concerns and issues within the service. No audits had taken place.”
moderateRecord keeping: “Staff recruitment records showed gaps in three members of staff employment history. These gaps had not been addressed and recorded.”
moderateMissed or late visits: “People and relatives told us staff were often late and they were not informed, which was frustrating.”
moderateIncident learning: “records showed that one person's relative reported the person had fallen. The provider had not updated the care plan for the person to alert staff that the person was at risk of falls.”
moderateLeadership: “service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.”
Strengths
· Staff were described as kind, caring and supportive, with positive feedback from people and relatives
· Effective safeguarding systems in place; concerns reported to the local authority
· Staff had access to enough PPE and followed government COVID-19 guidance
· Staff treated people with dignity and respected their privacy and independence
· Management team worked with occupational therapists, GPs and community nurses when needed
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongNot rated
safe: Using medicines safelyNot 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: 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: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; supporting people to access healthcareNot rated
caring: Ensuring people are well treated and supported; respecting 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
well-led: Managers and staff being clear about their roles; understanding quality, risk and regulatory requirements; continuous learningNot rated
well-led: Promoting a positive, person-centred, open and empowering cultureNot rated
well-led: Duty of candourNot rated
well-led: Engaging and involving people, the public and staffNot rated
well-led: Working in partnership with othersNot rated