Good Oaks Home Care - Aylesbury improved from Requires Improvement to Good across all five key questions, having remediated all six prior regulatory breaches relating to safeguarding, risk management, recruitment, medicines, infection control, person-centred care, consent, staffing, complaints and governance. Remaining minor concerns centre on inconsistent record-keeping in governance documentation and incomplete CQC notifications, for which a formal recommendation was made.
Concerns (6)
moderateGovernance: “further examples of notifications which had not been reported to CQC in line with requirements”
moderateMedication management: “one incident where an omission of medicines had not been appropriately reported to the local safeguarding authority”
minorRecord keeping: “the complaints log had not been fully updated with the actions taken in response to complaints”
minorRecord keeping: “information about accidents and incidents had not been consistently documented in line with the provider's policy”
minorEnd-of-life care: “7 staff who had been employed prior to June 2022 had not yet undertaken the same [palliative and end of life care] training”
minorCommunication with families: “A lot of the newer carers can't even speak English properly. Sometime they have to get things translated”
Strengths
· Staff were caring, compassionate and promoted people's independence, with people and relatives providing consistently positive feedback.
· Significant improvements made since previous inspection, with all prior regulatory breaches resolved.
· Registered manager was accessible, responsive and acted as a positive role model, praised by staff, people and families alike.
· Robust induction, training and competency assessment processes were in place for new and existing staff.
· Person-centred care plans were detailed and holistic, reflecting people's needs, wishes and preferred routines.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
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
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: Improving care quality in response to complaints or concernsGood
responsive: Meeting people's communication needsGood
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: Engaging and involving people using the service, the public and staffGood
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
Good Oaks Home Care - Aylesbury was rated Requires Improvement overall with Safe rated Inadequate at this first inspection, with eight regulatory breaches identified including safeguarding, safe care, medicines, recruitment, staffing, consent, person-centred care, complaints and governance, and a warning notice served under Regulation 12. A new manager and franchise head office had begun a service improvement plan and were responsive to inspector feedback.
Concerns (18)
criticalSafeguarding: “The service had failed to implement effective systems to identify, investigate and appropriately respond to allegations of abuse.”
criticalCare planning: “Risk assessments were either not present, had not been updated in a timely manner, or lacked sufficient detail to help staff understand and respond to risks.”
criticalMedication management: “The service had not ensured the proper and safe management of medicines, including record keeping of the administration of medicines.”
criticalConsent / capacity: “Effective systems were not operated to ensure the service worked in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice.”
criticalPerson-centred care: “Processes for assessing and reviewing people's needs were not fully effective in ensuring care met people's needs and preferences.”
criticalComplaints handling: “Systems were not operated effectively for identifying, receiving, recording, handling and responding to complaints.”
criticalGovernance: “Management systems were not operated effectively to assess, monitor and improve the quality and safety of the services provided”
criticalRecord keeping: “The service had failed to maintain securely an accurate, complete and contemporaneous record in respect of each service user.”
criticalOther: “Systems were not consistently operated for the safe recruitment of staff.”
moderateInfection control: “Records did not evidence staff uptake of COVID-19 tests... This could have placed people at increased risk from COVID-19 infection”
moderateIncident learning: “There was no evidence the service had undertaken a monthly analysis of accidents and incidents to identify where further action may be required to prevent reoccurrence.”
moderateStaff competency: “Processes for staff competency assessments, spot checks and supervisions had been inconsistently implemented.”
moderateStaff training: “existing data indicated no staff members had completed diabetes awareness or epilepsy awareness training... only three staff had completed managing behaviour training, and end of life care training.”
moderateSupervision / appraisal: “The staff member's first supervision had been carried out in November 2021, several months after commencing employment, and the meeting had been conducted by a colleague, not the person's supervisor.”
moderateStaffing levels: “Records showed staff often stayed less than scheduled visit times, staff were not always provided with sufficient travel time on rotas”
moderateMissed or late visits: “Their time keeping is terrible... they don't let me know...I don't know when they are supposed to come as I don't see the rota…there is no fixed time…they can come very late”
moderateLeadership: “The service had not demonstrated improvements following an audit conducted by the franchise head office in February 2021.”
minorCommunication with families: “There is a language barrier, most have English as their second language and then they are wearing masks.”
Strengths
· New manager understood regulatory requirements and had a service improvement plan in place at inspection
· Open and transparent culture; staff motivated and spoke positively about the new manager and nominated individual
· Strong support from the franchise head office including yearly full service audit and monthly support calls
· Positive multi-agency working with professionals, GPs, district nurses, hospital teams and commissioners
· Good stocks of PPE and staff observed using PPE appropriately throughout the COVID-19 pandemic
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
safe: Staffing and recruitmentNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot 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 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 diversity; 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, understanding quality performance, risks and regulatory requirements; continuous learning and improving careNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Duty of candourNot rated
well-led: Working in partnership with othersNot rated