During an assessment under our new approach
Date of Assessment: 12 May 2025 to 20 May 2025. This assessment was completed remotely. This service is a care at home service, providing support to older people living with dementia and physical disabilities. During this assessment the provider was in breach of regulations in relation to safe care and treatment and governance.
People were able to raise concerns; however, lessons were not always learned by the provider in response to issues about the service people received. Incidents and accidents were not consistently well recorded or appropriately investigated, leading to missed opportunities to reduce the risk of harm.
Risk assessments were in place, but some lacked sufficient detail, and others, particularly those related to people’s living environment and safe working conditions, were missing. Information in care plans was not always person centred and required further development to help support new staff. Although staff were trained, there were no up-to-date records of staff supervision.
Feedback from people and staff was positive regarding the caring nature of the staff. People had enough to eat and drink to stay healthy, and staff worked together with other agencies involved in individuals' care to promote the best outcomes and ensure smooth transitions between services. Staff ensured that people understood their care and treatment, enabling them to give informed consent. Where individuals lacked capacity, staff involved those important to them and followed best interest decision-making processes.
People’s privacy and dignity were respected. Staff treated them as individuals, supported their preferences, and encouraged choice in their care. People were also supported to maintain relationships with family and friends, and staff responded to their needs in a timely manner.
People were involved in decisions about their care and were provided with information they could understand. They knew how to give feedback and felt confident that the provider listened and acted on it.
Despite the provider being hands-on and visible, there remained a lack of effective oversight. The provider missed opportunities to identify and mitigate risks. Audit systems were neither robust nor effective and failed to highlight some key areas requiring improvement.