JK Caring Carers Ltd was rated Inadequate overall following a focused November 2022 inspection, with continued regulatory breaches across safe care and treatment (Reg. 12), staffing (Reg. 18), fit and proper persons (Reg. 19), and good governance (Reg. 17), including Warning Notices served. The service was placed in special measures due to persistent failures in risk management, unsafe recruitment, widespread late calls, ineffective governance, and a lack of learning from previous inspection findings.
Concerns (14)
criticalCare planning: “Risks for people were not identified, recorded and mitigated in relation to their care and support needs.”
critical
Medication management
: “Not all staff who administered people's medication had achieved up to date medication training and care plans did not clearly and accurately document the level of medicine support required.”
criticalMedication management: “Neither the risk assessment nor Medication Administration Record [MAR] provided guidance for staff detailing how much thickening agent was to be used.”
criticalStaffing levels: “Out of 4100 care calls delivered, 1165 calls were more than 45 minutes late... 1678 calls had no travel time included.”
criticalStaff training: “Not all staff employed at the service had attained up to date mandatory or specialist training relating to the needs of the people they supported.”
criticalGovernance: “Governance arrangements had not identified staffing shortfalls... lessons were not learned as failings identified had not been addressed by the provider.”
criticalIncident learning: “There was no evidence of continuous learning and improvement. Lessons were not learned as failings identified had not been addressed by the provider.”
criticalLeadership: “The registered manager did not understand the importance and responsibilities of their role to ensure compliance with regulatory requirements.”
criticalSafeguarding: “Recruitment practices remained unsafe... DBS checks were not completed or received until after staff had commenced in post.”
moderateMissed or late visits: “They [staff] are all over the place... the biggest problem is that staff are not on time.”
moderateStaff competency: “Staff did not have up to date training... not all staff had received formal supervision.”
moderateSupervision / appraisal: “Not all staff had received formal supervision and it was unclear from the records viewed if staff had received regular 'spot visits'.”
moderateRecord keeping: “The registered manager failed to keep accurate and up to date records for people using the service and staff.”
moderateComplaints handling: “Not all complaints and concerns raised via the domiciliary care agency recorded information detailing the actions taken and if the complaint was resolved.”
Strengths
· People told us they felt safe and had no concerns about their safety or wellbeing when staff visited them.
· Staff had access to adequate supplies of Personal Protective Equipment including face masks, aprons, gloves and hand sanitiser.
· People had access to healthcare professionals as required to support their ongoing healthcare needs.
· People's capacity to make decisions had been assessed and staff sought people's consent prior to providing support.
· Staff demonstrated an understanding of what to do to make sure people were protected from harm or abuse.
Quality-Statement breakdown (13)
safe: Assessing risk, safety monitoring and management; Using medicines safelyInadequate
safe: Staffing and recruitment; Learning lessons when things go wrongInadequate
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices, delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Promoting a positive culture; Duty of candour; Continuous learning and improving careInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: Working in partnership with othersRequires improvement
First inspection of a domiciliary care agency rated Requires Improvement overall, with breaches of Regulations 12, 17, 18 and 19 covering recruitment, medicines/risk management, staff training and induction, and governance. Caring and responsive aspects were rated Good, with positive feedback on dignity and consistency of care, though punctuality and complaints investigation required improvement.
Concerns (10)
criticalGovernance: “The quality assurance and governance arrangements in place were not effective in identifying shortfalls in the service.”
criticalStaff competency: “Recruitment checks had not been completed on new staff to check their suitability or competence to work with vulnerable people prior to commencing employment”
criticalMedication management: “Staff had received medication training but had not had their competency assessed through direct observation to ensure they were administering medicines safely.”
moderateStaff training: “Staff had not completed an assessment to demonstrate their knowledge and competence at the end of each training session.”
moderateSupervision / appraisal: “Not all staff had received regular supervision or 'spot check' visits.”
moderateMissed or late visits: “there was negative feedback about staff's punctuality and people were not routinely notified if staff were running late.”
moderateCare planning: “not all risks for people were identified and recorded... Risks relating to specific health conditions had not been considered or recorded.”
moderateConsent / capacity: “People's capacity and ability to make decisions was not assessed and recorded.”
moderateRecord keeping: “Most areas of the document were not completed and remained blank. This did not provide assurance that the registered manager had clear oversight of the service”
minorComplaints handling: “details of the investigation and action taken were not robust and required improvement.”
Strengths
· People felt safe and had no concerns about their safety or wellbeing when staff visited.
· Staff were patient, kind and caring; people treated with dignity and respect.
· Most people received care from a consistent staff team, promoting continuity.
· Staff had appropriate infection prevention and control training and access to PPE.
· Care plans detailed level of support, number of staff and length of visits.
Quality-Statement breakdown (19)
safe: Staffing and recruitmentNot rated
safe: Assessing risk, safety monitoring and management; Using medicines safely; Learning lessons when things go wrongNot 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 to maintain a balanced dietNot rated
effective: Staff working with other agencies to provide consistent, effective, timely care
Not rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot 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 preferences; End of life care and supportNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
well-led: Promoting a positive culture; Continuous learning and improving care; Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated