Malachi Care Services was rated Requires Improvement overall at its first inspection, with a breach of Regulation 17 (Good governance) due to inadequate audits, poorly completed consent records, undetailed risk assessments and unsafe recruitment checks. Caring was rated Good, with positive feedback on staff kindness and dignity, but communication, nutrition support and personalised care planning needed improvement.
Concerns (10)
criticalGovernance: “Governance arrangements within the service were not adequate to ensure safe, good quality care was being delivered. This was a breach of regulation 17 (Good governance)”
moderateRecord keeping: “We checked care notes, and found they contained errors and omissions... the audit had failed to identify these shortfalls.”
moderateCare planning: “There were risk assessments in people's care records, however they lacked detail and were not sufficient to ensure people's safety.”
moderateStaff competency: “staff have limited skills, with some not knowing how to operate kitchen equipment.”
moderateStaff training: “I think that they need more training and they need to be more proactive... I don't think that they are experienced or trained enough.”
moderateCommunication with families: “People told us they did not feel staff communicated well with them, with several raising concerns about communication barriers.”
moderateConsent / capacity: “the records we checked were not correctly completed; people had signed them but their choices in relation to consent were not recorded.”
moderatePerson-centred care: “Each care plan we looked at held only limited information about people's preferences.”
moderateOther: “Staff files showed that the provider had not obtained a full record of their work history before commencing work. References lacked detail, and in one staff member's file the references were blank.”
minorStaffing levels: “they said continuity of staffing had diminished in recent months.”
Strengths
· Medicines management was appropriately followed with staff trained and competency regularly checked.
· Infection control procedures were followed and PPE was plentiful and used consistently.
· Staff were described as kind, respectful and supportive of people's dignity and independence.
· Staff reported a supportive culture and good quality induction and training.
· Service worked in partnership with external healthcare professionals (GPs, district nurses, continence specialists).
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
safe: Staffing and recruitmentNot rated
safe: Learning lessons when things go wrongNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot 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 live healthier lives, access healthcare services and supportNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Ensuring people are well treated and supported; equality and diversityNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Meeting people's communication needsNot rated
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Engaging and involving people using the service, the public and staff; Working in partnership with othersNot rated