A Caring Hand Ltd was rated Requires Improvement overall following a focused inspection of Safe and Well-Led, with continued breaches of Regulations 17, 18, and 19 relating to poor governance, inadequate staff training and recruitment, unsafe medicines management, and ineffective risk assessment. This is the second consecutive Requires Improvement rating, with insufficient progress made since the previous inspection in February 2022.
Concerns (12)
criticalMedication management — “I haven't had any training with medicines and my competencies have not been checked. Another person: I haven't had medicine training yet. This person was supporting people with their medicines.”
criticalCare planning — “4 out of 5 risk assessments we reviewed did not contain information relating to people's risks. Care plans were ineffective at providing guidance to staff, exposing people to the risk of harm.”
criticalRecord keeping — “The provider had failed to ensure there were accurate and complete records in respect of each person, to evidence the care and treatment provided to them was in line with their assessed needs.”
criticalStaff training — “Training records were missing training information such as; diabetic care, eye drops, PEG training. The training matrix did not contain information for all staff working for the company.”
criticalGovernance — “Audits were either not undertaken regularly or in some instances were not completed at all. No audits of medicines administration records (MARs).”
criticalStaffing levels — “2 members of staff had been working without a DBS. We did not see any risk assessments in place to mitigate the time period.”
moderateSupervision / appraisal — “Supervisions were not conducted, and spot checks were inconsistent. The provider was unable to demonstrate systems in place to determine when spot checks were due or had occurred.”
moderateIncident learning — “Records did not show actions taken in response to incidents. There was no evidence the service had undertaken an audit or wider analysis of accidents and incidents to identify themes or trends.”
moderateSafeguarding — “Records did not confirm all staff had received training in safeguarding adults. Staff were not always sure who to contact if they had wider concerns such as the local authority.”
moderatePerson-centred care — “People's views and decisions about support were not always incorporated in their support plans. This meant staff were not always aware of how to support people in a way that allowed people to have control.”
moderateLeadership — “I feel like I'd be shut down if I suggested a change. Staff did not always feel they were involved within the service development or given an opportunity to be heard.”
minorInfection control — “A chap who turned up without a uniform and occasionally the males don't wear aprons. Management was unsure of when this message was communicated to staff.”
Strengths
· People and relatives reported feeling safe and were happy with the care received, with staff going above and beyond during calls.
· Staff understood their responsibilities to identify and report safeguarding concerns to management.
· The service supported people to access a range of health and social care professionals including GPs, district nurses, and social workers.
· The registered manager understood and applied the Duty of Candour and was responsive to issues raised during inspection.
· People were supported to have maximum choice and control of their lives in the least restrictive way possible.
A Caring Hand Ltd received an overall rating of Requires Improvement at its first CQC inspection, with a breach of Regulation 17 (Good Governance) identified due to ineffective quality assurance systems, absent late-visit recording, and gaps in medicine administration records. Care delivery was generally positive, with Good ratings across Effective, Caring and Responsive domains and staff and people reporting warm, person-centred interactions.
Concerns (7)
criticalGovernance — “Systems were not always in place or effective to ensure all documentation was accurate and up to date. Whilst there were some quality assurance checks carried out, these were not always effective.”
moderateRecord keeping — “We saw on one person's November 2021 MARS, there were several gaps with no staff signatures and no explanations recorded on the MARS.”
moderateMissed or late visits — “There was no system for recording late visits to people, which meant the registered manager had no way of checking how many occurred, if any.”
moderateStaffing levels — “The registered manager confirmed there had been staffing shortages, due to COVID-19, general staff sickness and the ongoing challenge of recruiting appropriate new staff.”
moderateMedication management — “On the medicine administration record (MAR) for one person on six occasions in October 2021, the staff member could not give the person their eye drops as they had not been trained in this task.”
moderateCare planning — “People's records were in the process of being reviewed as some contained conflicting information leading to uncertainty about the accuracy and relevance of the information.”
minorSupervision / appraisal — “There was a staff spot check and supervision spreadsheet in place, however, it was difficult to assess accurately how often staff were receiving this type of support as dates varied.”
Strengths
· People and relatives gave mainly positive feedback about the caring attitude and competence of staff.
· Staff received training across a range of subjects including medication management, safeguarding and infection control.
· Safe recruitment practices were in place with employment gaps identified and explained.
· Complaints were managed consistently with evidence of seeking feedback from complainants to drive improvement.
· People were supported in line with Mental Capacity Act principles and given choices in their day-to-day care.
Quality-Statement breakdown (22)
safe: Staffing and recruitmentRequires improvement
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: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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 careGood
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: 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 control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
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 requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood