ApproCare, a domiciliary care agency in Sheerness, Kent, was rated Requires Improvement overall following a focused inspection of Safe and Well-led, having deteriorated from Good since its 2019 inspection. Three regulatory breaches were identified (Regulations 12, 13, and 17), covering failures in safeguarding, risk management, care planning, staff training, and governance.
Concerns (15)
critical
Safeguarding
: “The provider had failed to safeguard people from abuse and improper treatment. This was a breach of regulation 13 Safeguarding of the Health and Social Care Act 2008.”
criticalSafeguarding: “The registered manager had not notified the Commission of a safeguarding incident. Statutory notifications are required to be submitted where there are allegations of abuse.”
criticalCare planning: “Comprehensive assessments of each person's physical and mental health were not conducted before accepting the care package.”
criticalGovernance: “The provider had failed to ensure effective systems and processes were established and operating effectively to assess, monitor and improve the service. Breach of regulation 17.”
criticalStaffing levels: “Staff told us they are expected to do multi handed calls on their own if there are not enough staff. Another told us they responded by 'Cutting corners…We don't have time to watch them eat.'”
moderateCare planning: “People with identified learning disabilities did not have this documented within their care plans or considered, such as how this may affect their understanding.”
moderateCare planning: “Entries in care plans were confusing and contradictory. One person who used a wheeled walker was recorded to not use mobility aides and be at low risk of falls.”
moderateIncident learning: “The registered manager told us they spoke with staff at the time of concerns being raised but did not retain records to identify themes or learning.”
moderateStaff training: “Staff had not completed their annual training. One staff member had not completed 17 of their 22 training modules and continued to provide care during this period.”
moderateStaff training: “Staff told us all the training was online and some felt it did not provide them with the opportunity to apply the learning in practice.”
moderateStaffing levels: “A person told us, 'They couldn't give me my time for the visit as everyone wants that time and they didn't have enough carers.'”
moderateSupervision / appraisal: “Staff told us their practical assessments were pre-populated and they were not spot checked during visits to ensure standards of care were maintained.”
moderateLeadership: “Some staff told us they felt unable to raise concerns with managers without fear. Two staff members told us if they complained they were 'put on the naughty step' and their hours were reduced.”
moderateRecord keeping: “Records did not include actions taken by staff to reduce/manage the risks of people not taking their medication, failing to have bowel movements for days or confirming food/fluid consumption.”
minorComplaints handling: “Staff told us the management team had asked them to apologise to a person on their behalf but did not provide information on actions taken to address the complaint.”
Strengths
· People felt safe and trusted staff; a person said, 'I am honestly really happy with them.'
· Medicines records had been completed appropriately and staff supported people to make their own decisions about medicines.
· Staff used personal protective equipment (PPE) effectively and safely.
· The service was consistently working within the principles of the Mental Capacity Act.
· General environmental risks and fire hazards had been assessed for staff.
Quality-Statement breakdown (11)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and management and learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
safe: Using medicines safelyGood
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 empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement