ReadyCQC, a weekly field guide to CQC home-care regulation

Concerns (12)

criticalMedication management: “A statin for high cholesterol…recorded on the MAR as administered twice [on 4 days] which had not been identified in the MAR audit.”
criticalMedication management: “The reason why a PRN medicine had been administered was not recorded to ensure it was given appropriately and as prescribed.”
criticalCare planning: “Where a person's care needs had changed this was not reflected in their care plan to ensure staff were providing the support to meet the person's current needs.”
criticalStaff training: “Staff were providing support for people living with diabetes and Parkinson's Disease but there was no record of the staff members completing training in relation to these conditions.”
criticalConsent / capacity: “Mental capacity assessments had been completed but these did not consider the specific aspects of the care provided to identify if the person could consent.”
criticalGovernance: “The provider's quality assurance systems were not operated effectively as they were still in breach of the regulation and Warning Notice.”
moderateCare planning: “The care plans for some people were still focused on the care tasks and did not always provide information on how the person wanted their care provided.”
moderateStaff training: “3 did not have any records of an induction being completed before they commenced providing care and support.”
moderateRecord keeping: “Care records did not include enough detail about people's care needs and associated risks and were not always up to date.”
moderatePerson-centred care: “People's care plans did not always include information on the person's communication support needs and how staff could assist them.”
moderateIncident learning: “Checks carried out on the records completed by staff did not always clearly show important information had been escalated to senior staff or the person's relatives.”
minorCommunication with families: “People and relatives informed us they were rarely, if ever, informed if the staff member was running late for a visit.”

Inspection report · 2023-07-27

Framework: KLOE · 20 pages · 106 KB · PDF

Inadequate

safe: Inadequateeffective: Requires improvementcaring: Requires improvementresponsive: Requires improvementwell-led: Inadequate

Immaculate Care Limited was rated Inadequate overall at its first inspection in October 2022, with breaches across six regulations including safe care and treatment, staffing, recruitment, care planning, consent, and governance. The service was placed in special measures due to widespread failures in medicines management, risk assessment, staff training, care planning, and a lack of open and transparent leadership.

Concerns (17)

criticalMedication management: “Medicines were not managed in a safe way. The medicine administration record (MAR) did not contain information on whether the person had any allergies or information on the person's GP.”
criticalStaffing levels: “Staff were not always given enough travel time in between calls. We saw from one rota that a member of staff was given five minutes to travel from one person to another.”
criticalStaff training: “Staff had not always received training specific to the needs of people they supported. There were staff that regularly supported people with Parkinson's and diabetes, yet no staff had received training on this.”
criticalStaff competency: “One member of staff, who had no background in care, had only completed two care calls and then started providing care independently the following day.”
criticalCare planning: “Care plans lacked detailed and guidance for staff. Care plans lacked information about people's backgrounds, interests and things that were important to them.”
criticalSafeguarding: “Staff had a lack of understanding of what they would do if they needed to report the concerns outside of the organisation. Staff we spoke with did not know who the agency was that dealt with safeguarding.”
criticalIncident learning: “Accidents and incidents were not always recorded with the actions taken to reduce further risks... The registered manager was not collating all the incidents and accidents.”
criticalGovernance: “There was a lack of auditing by the provider and registered manager to identify where improvements needed to be made... None of these areas had been audited.”
criticalLeadership: “The provider and registered manager were not open and transparent with us at the inspection... The provider said, 'We added those names just to populate the staff as we don't want you to know.'”
criticalConsent / capacity: “The provider and registered manager were not aware of the principals involved to safeguard the rights of people who were assessed as being unable to make their own decisions.”
moderateSupervision / appraisal: “When we reviewed staff files, we saw there were staff that had only received one supervision since July 2022.”
moderateEnd-of-life care: “People were not always supported with their end of life care planning. There was no information in their care plans on discussions with them and their relatives on their wants and wishes.”
moderatePerson-centred care: “People life histories, likes, dislikes and interests were lacking in their care plan... Staff we spoke with were not familiar with people's life histories.”
moderateMissed or late visits: “People and relatives told us that in the main staff arrived at the calls. However where two staff were required to support a person on each call this was not always taking place.”
moderateRecord keeping: “We saw from the daily notes for people that staff were not accurately recording when they arrived and left a person's home.”
moderateCommunication with families: “People and the families were not always told when care staff were running late. One relative said, 'There is no point ringing her cos she has dementia, they really need to ring me if they're running late.'”
minorInfection control: “Relatives fed back that staff were not always wearing personal protective equipment.”

Strengths

· People and relatives reported feeling safe with staff and commented positively on their kind and caring nature.
· The provider worked with external health and social care organisations and liaised with healthcare professionals to monitor people's health needs.
· The registered manager reported safeguarding concerns to the Local Authority where appropriate and informed CQC of significant events.
· Staff demonstrated understanding of infection control procedures.
· Complaints received were investigated thoroughly, with follow-up action taken with staff.

Quality-Statement breakdown (18)

safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidance

Inspection reports (3)