“Training alone isn't enough; without proper systems and governance, even the best intentions can fail. This CQC report reveals how neglecting comprehensive training and oversight led to widespread inadequacies in care” - Lorraine Hunt

Introduction:

Here at Transform Your Training, I’m dedicated to providing insights, training, and education for registered managers and home care business owners. Today, I’m launching a new series that breaks down CQC reports for home care services, focusing on key findings contained within the report that impact training and development. I’ll also provide some actionable tips for the provider that you could learn from to help you stay compliant and improve the quality of care you provide.

Prefer to watch the summary video instead?  Click here to watch on YouTube.

Understanding the CQC Report

The CQC report I’m looking at today is for a home care provider, rated inadequate in April 2024. The inspection, which took place in 2023, covered multiple visits.  This service had previously been rated as Inadequate.

Alarmingly, all key questions were rated as inadequate.

Key Facts:

• Service Type: Domiciliary care

• Initial Disclosure: 12 people using the service, then jumped to 88

• Actual Number: 92 people using the service

• Main Issue: Provider could not demonstrate right support, right care, right culture and did not even know the correct amount of people using it’s service

Learning Point : Know your service, your clients and staff and your key numbers.

Safety concerns

The report highlighted significant safety concerns, including inconsistent protection from abuse and neglect, inadequate medicine management, and insufficient risk assessments.  All of which could be avoided with adequate training and governance systems in place.

Specific Issues Identified:

• Inadequate care plans: Poor guidance in care plans prevented carers from properly responding to and de-escalating situations.

• Staff training: Inadequate training identified on the Mental Capacity Act (MCA) - although there are other training failures further on.

• Auditing failures: Lessons from previous inspections were not incorporated into audits, and inadequate audits were still taking place.

• Communication: Poor communication skills among staff affected interactions with clients and relatives.

• Medicine management: No clear guidance on medicine protocols, lack of adequate training and competency checks.

• Pre-employment checks: Incomplete checks and insufficient staff skills.

• Poor practices: Missed or late medications, incorrect protocols, poor records, and unsafe manual handling practices.

• Lack of Staff: Insufficient staffing impacted call timings and travel efficiency.

The problems can be overcome

A lot of these issues stem from inadequate training for management, office teams, and care staff. Proper systems and governance need to be in place first!

Inadequate care plans and up-to-date risk assessments

Ensure robust risk assessments and care plans are completed prior to commencing care and that these are regularly updated as required, or at least reviewed annually. All registered managers should be trained in comprehensive risk assessments and care plans and there must be a process in place for staff to escalate changes effectively to the office teams.

These assessing risk and care planning courses, which I will be offering shortly, have been mandatory in previous organisations I’ve worked with and go hand in hand with a robust governance system.

Effectiveness issues identified as inadequate

Effectiveness was compromised due to a lack of personalised care plans and failure to meet people's needs and preferences. 

Training was outdated, predominantly online, and failed to ensure staff competency.

Actions that could be taken:

• Conduct comprehensive risk assessments: Involve individuals and their families. Regularly review and update care plans.

• Audit training compliance and effectiveness: Assess requirements and effectiveness and implement a robust retraining program, as well as implement effective induction and annual refresher mandatory training.

Quality of care - Caring

The quality of care was poor, with reports of undignified treatment and lack of respect for individuals' preferences. 

Culture starts from the top—if the leadership doesn’t care, how can they expect others to?

Focus on person-centred care:

• Train staff to respect and value each individual's preferences, privacy and dignity.

• Seek regular feedback from clients, family members, and staff to improve care practices.

Responsiveness

The service was unresponsive, with frequent complaints about missed, late, or short care calls. Complaints were not listened to or acted upon, and no lessons were learned.  There were also issues identified with the on-call system, or management spreading themselves too thin and not covering all the branches.

Focus on improvements:

• Ensure timely and consistent care.

• Review complaints policy and process and train those who deal with them to do so effectively

• Train carers to recognise when a complaint has been received and what action to take.

Leadership failures

Leadership was inadequate, with poor oversight and ineffective governance systems. There was no clear information or sufficient detail in risk management, and auditing care calls were ineffective.

Implement governance and quality assurance frameworks:

• Regular audits and compliance checks and action taken against findings

• Foster an open culture where staff feel supported and empowered to raise concerns.

CQC Regulatory and Enforcement actions taken

The report lists numerous breaches and enforcement actions against various regulations. It is critical for this organisation to develop a comprehensive action plan to address each of these issues.

Action Plan

Whilst this is not a comprehensive action plan, some points that could be considered are:

Safety

1. Safeguarding training:

   • Implement comprehensive safeguarding and MCA training for all staff immediately.

   • Conduct regular refresher courses.

2. Medicine management:

   • Review and update all medicine management protocols.

   • Conduct audits and train staff on medication administration.

3. Risk assessments:

   • Conduct and regularly review comprehensive risk assessments.

Effectiveness

1. Personalised care plans:

   • Review current plans and engage with clients and families to update to personalised plans.

   • Train staff on involving clients, family in care planning and ensure robustly covers all aspects of writing care plans.

2. Comprehensive assessments:

   • Conduct thorough initial and regular risk assessments and reviews for clients.

3. Feedback mechanisms:

   • Establish regular feedback sessions with clients, families/loved ones and care teams.

Caring

1. Dignity, privacy and respect training:

   • Conduct training sessions focused on treating clients with dignity and respect.

2. Cultural sensitivity training:

   • Provide training on cultural sensitivity and respect for diverse backgrounds.

3. Monitoring and enforcement:

   • Conduct regular spot checks and implement a zero-tolerance policy for undignified treatment.

Responsiveness

1. Scheduling system review and overhaul:

   • Implement a robust scheduling system - is it working as it should, are staff trained to produce appropriate runs and do they know enough about their carers to learn their hours requirements.

2. Staffing levels:

   • Review and adjust staffing levels to ensure adequate coverage.  Sometimes easier said than done but are there adequate staffing levels, with poor management of hours, or is it that there are genuinely not enough staff to cover requirements?

3. Communication improvements:

   • Establish clear lines of communication between the office, caregivers, and service users.

Leadership and Governance

1. Governance framework:

   • Develop and implement a comprehensive governance framework, including audits and regular quality assurance reviews with business owners, nominated individuals, Registered manager as well as other key stakeholders.

2. Complaints Process:

   • Revamp the complaint policy and handling system and train the same to various levels within the care provider.

3. Transparency and communication:

   • Foster a culture of transparency and effective communication.  Are internal communication systems fit for purpose or could they look to implement something as simple as Slack to consolidate all communication to one central place?

4. Leadership development:

   • Provide leadership training for managers that is practical and provides actionable insight, rather than theory based learning that does not help anyone.

Compliance and Continuous Improvement

1. Regulatory Compliance:

   • Regularly review and audit compliance with CQC regulations and outstanding care practices.

2. Continuous improvement program:

   • Establish a continuous improvement program.

Conclusion

In summary, the CQC report highlights critical areas for improvement. Training and organisational development are key to addressing some of these issues, but not all. 

Training alone is not enough; proper systems and governance are an essential first step and should be seen as a building block.

Ready to transform your training from MEH to Memorable or indeed need your training program to have a complete overhaul? EMAIL ME - [email protected]

Stay tuned for my next post where I’ll, hopefully, cover an outstanding home care provider. Have a specific CQC report you’d like me to cover next? Let me know over socials or drop me a message!

Key actionable insights checklist:

Here's some key actionable insights that home care business owners and registered managers could use to improve their own services:

• Know your service and the numbers that matter: regularly update them

• Ensure your records are accurate and up-to-date, especially if you are still using paper based records (why you should be in 2024 is beyond me!)

• Implement comprehensive training for all staff that follows best practice and AT LEAST covers mandatory training

• Conduct regular mandatory refresher training courses

• Ensure all staff receive regular, effective training on key topics, including MCA, person centred care, safeguarding, etc - start by signing up to my weekly tips that I email managers so they can copy and paste with their teams - Click HERE to sign up

• Develop and implement robust induction and refresher training programs

• Establish strong governance and quality assurance auditing and compliance processes

• Improve communication skills amongst staff not only in the way they treat clients, but in how they communicate with each other and with the office

• Are your risk assessments and care plans adequate? If not, why not? If you dont know, find out or get them audited externally

• Provide leadership training for managers, ensuring they are visible and accessible to both staff and clients

• Implement robust scheduling system and train your users on how to actually schedule effectively

• Review your complaints policy and ensure everyone is trained on appropriate action to take

• Regularly review and audit compliance with CQC regulations and best practice