Caring for You was rated Inadequate and placed in special measures following a focused inspection that found continued breaches in safe care, staffing, recruitment, safeguarding and good governance. The provider had failed to act on previous inspection findings, with unsafe recruitment, no competency checks, outdated policies, absent supervision and a lack of oversight placing people at risk of harm.
Concerns (13)
criticalStaff training: “some staff had undertaken training in the form of e-learning, but this was insufficient to ensure all staff had the necessary skills to support people with their specific needs”
criticalStaff competency: “There was no evidence of any competency checks carried out to ensure staff were able to safely provide care.”
critical
Governance
: “The registered provider lacked oversight of the service delivery and there were no robust systems and processes to assure the quality of the care provided.”
criticalRecord keeping: “continued breaches in relation to people's safe care, staffing, recruitment and good governance, including record keeping”
criticalSafeguarding: “The provider's safeguarding policy and procedure had not been reviewed or updated since 2015.”
criticalMedication management: “There was no evidence staff had been observed or assessed as competent to support people with medicines. This had been reported on at the last inspection, with no action taken to improve.”
criticalCare planning: “Individual risk assessments were not always completed or lacked information for staff to support people safely.”
criticalSupervision / appraisal: “There was an absence of staff supervision records in the five staff personnel files we saw, and staff supervision was not delivered in line with the company's policy of six times per year.”
criticalLeadership: “The provider was not able to demonstrate the competency required to carry on and manage the regulated activity.”
criticalIncident learning: “The provider had been in breach of regulations at the last inspection, although there was limited evidence of action taken to drive improvements.”
criticalOther: “Recruitment procedures were not followed and staff were employed without any evidence of interview or suitability checks carried out.”
moderateInfection control: “At the last inspection, no staff had completed infection prevention and control training. At this inspection, only two staff had completed this training.”
moderateConsent / capacity: “not sure how people's mental capacity was determined other than as part of the initial referral information received”
Strengths
· People and relatives were mostly positive about the way the care staff supported them in their homes.
· People said they felt safe and relatives did not express any concerns about safety.
· Staff told us they engaged in regular testing and had a continuous supply of PPE; people and relatives said staff always wore PPE.
· Relatives said staff kept them informed: 'If anything goes wrong, they'll phone to let me know.'
· Care records showed staff involved relatives and other health professionals in support of people's care.
Quality-Statement breakdown (9)
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture; engaging and involving people; continuous learning and improving careInadequate
well-led: Duty of candour and working in partnership with othersInadequate
Focused inspection of Caring for You found enough improvement to lift the service out of Special Measures, with previous breaches around recruitment, staffing, safeguarding and risk addressed. However a continued breach of regulation 17 (good governance) remained due to incomplete records, limited audit oversight and policies still being updated, leaving Safe and Well-led rated Requires Improvement.
Concerns (6)
criticalGovernance: “Records to demonstrate how people's needs were safely met, and to demonstrate consistent management of the service, were not fully in place and were still being updated.”
moderateRecord keeping: “Some gaps in care records suggested care had not been provided at times identified; the registered provider explained this was in part down to poor internet connection”
moderateSafeguarding: “systems and processes were not robustly in place to show how people would be protected from financial abuse and how staff are protected against allegations.”
moderateMedication management: “where one person's MAR chart was handwritten, this was done by only one member of staff. Two members of staff checking this record would ensure the transcription of the medicine was accurate.”
minorCommunication with families: “People did not receive a scale of charges or a contract to show how much they paid for their care.”
minorCare planning: “Care plans were in the process of being improved using new person-centred documentation... This was work in progress at the time of the inspection.”
Strengths
· More robust staff recruitment processes including DBS checks now in place
· Improved induction, supervision, training matrix and competency assessments for staff
· People and relatives reported feeling safe and were complimentary about care quality
· Infection prevention and control training increased to nearly 87 percent of staff
· Management consultant brought in to drive improvements; clearer lines of accountability
Quality-Statement breakdown (9)
safe: Staffing and recruitmentNot rated
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: Learning lessons when things go wrongNot rated
safe: Preventing and controlling infectionNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering