Kando Care Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 2 breaches of the legal regulations. People were happy with the care and support they received; however, people’s care records and risk assessments did not always provide sufficient guidance for staff, as there were missing risk assessments. This resulted in a breach of regulation 12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Potential new staff to the service underwent a series of checks to help make sure they were safe to support people. However, these records were not always of the standard required. This resulted in a breach of regulation 19 Fit and proper person employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. People were happy with staffs’ skills and knowledge. Staff had training, supervisions, and their competencies to deliver care checked. However, training certificates viewed, sometimes included up to 7 different topics trained in one session. This would increase the risk of learning not being embedded. The registered manager run refresher sessions on training topics with staff to help embed their skills and knowledge. People were supported by a consistent staff team, who knew their individualised needs and preferences well. There were enough staff to support people’s care call visits. People told us that staffs' timekeeping was good and that they experienced no missed care call visits. Staff completed safeguarding training and understood their role in keeping people safe. Staff knew how and where to report any concerns to. People had no concerns about how staff supported them with their medicines. The management team and staff shared learning. However, records throughout the service were not always to the standard required.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People confirmed they could raise concerns with staff, and these would be dealt with appropriately. A relative said about recent lessons learnt, “They did act on a concern before, and we were happy with their response.”

Staff felt encouraged to raise concerns to the management of the service and give feedback because of learning. A staff member said about their staff meetings where concerns and feedback were shared. They told us, “Yes we do, ours are very useful, we meet to discuss what is going on and any recommendations in our care.” The registered manager confirmed their process to share lessons learnt. They said, “We would use team meetings to share knowledge but (this is) limited due to only 3 service users. We tell staff about major changes, e.g. if someone is end of life, we share this. Everybody needs to be aware of what's happening.”

The provider had systems in place to report accidents and incidents and record the actions taken. Accidents and incidents were also discussed at staff meetings to help embed learning. However, records to log this needed improvement. The registered manager told us about 3 incidents that had occurred, and the incident and accident log evidenced during this assessment had only 1 incident recorded on it. This told us that the service's records needed to improve.

People told us their wishes and needs were considered before they started to use the service. People had access to external health advice and attended appointments. A person told us they were confident that staff would support them when needed. They said, “It hasn't happened before but yeah, yeah, they would contact GP or ambulance.”

Staff were aware of when people had health or social care professional input. Staff were also aware of what they needed to do and what information to review to help ensure a person’s smooth transition back to the service. This included, after a person’s stay in hospital. The registered manager gave an example and explained, “We have social workers we talk to, district nurses, GPs, local pharmacies, chemist.”

The external organisation who had undertaken a quality assurance visit to this service in 2023, did not offer any feedback to the CQC about staff practice in this topic.

People wherever possible, received a continuity of care when first new to the service. A pre assessment of the person’s requirements was completed to make sure staff could meet their needs. This information included details and input of any external health and social care professionals who were working with the person. Also, the management team were aware of any changes to a person’s health and care and support needs, following a hospital admission or health appointment. However, records throughout the service were not always to the standard required.

People felt safe receiving care and support from staff at Cambridgeshire. One person told us they felt, "Very, very safe."

Staff understood their responsibilities to keep people safe. One staff member said when asked the process of reporting concerns, “We first contact (care services) care coordinator or (my) line manager, record and then action (is) taken, report to local authority.” The registered manager told us, “If there is some form of abuse, I am going to report it up, gathering evidence, document everything...”

There were systems and processes in place to guide staff on how to protect people from the risk of harm and poor care. However, we found that there were no formal records held and audited by the service to ensure that a person would not be at an increased risk of financial abuse. People’s mental capacity to make day to day decisions and more complex decisions were assessed. During this assessment, records showed that no one using the service lacked mental capacity to make decisions. However, for one person it was recorded in their records that it was ‘unknown’ as to whether there was a lasting power of attorney document in place for them. This is an important legal document which allowed a person to give people they trusted, authority to manage their affairs.

People and a relative had no concerns about the care and support staff provided. People were supported by a consistent staff team who knew them well. Staff involved people and or their relative, where appropriate, in the setting up and reviews of people's care records. A person said, “When I started, the office (staff) came to meet me, we spoke about everything, we spoke about what they have to do for me and then they started sending the (staff).”

Staff had good knowledge of people's needs and how to support them to keep the person safe. A staff member told us where information around people’s known risks were held. They said, “They are in the folder in the (persons) house and (I) have read them.”

Risks to people were not always adequately assessed. At times, the service relied on staffs’ knowledge of the people they supported as they knew them well. People’s care records were detailed in places, however, not all risk assessments were in place to monitor people’s known risks. This included a missing risk assessment for a person’s known medication risk. Records did not always contain enough information to guide staff on how to support people safely. There was no formal process in place to document that people and or their relative were engaged in the setting up of and review of the person's care needs and risks.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us there were enough skilled and experienced staff to cover their care call visits. People confirmed to us that they had not experienced any missed care call visits. A person said, “(Staff had) never not turned up.” Staff informed people if they were running late. When asked if staff had the right skills and experience to support them, a person told us, “Well yes.”

Staff underwent a series of checks during their recruitment. One staff member said, “Before I came here, I was interviewed by the company and then a background check and made to do the care training and get certificate.” The registered manager talked through the recruitment process that was conducted on potential new staff. They confirmed that when a staff member was first employed, they would, “Work closely with (new staff member) for the first week,” and, “Register (the new staff member) for care certificate e-learning which they have to complete before coming to the country.” The care certificate is nationally recognised training for people working in social care. The registered manager told us they had enough staff to cover people’s scheduled care call visits. They said, “We have plenty of staff and hours to cover in a crisis.” Staff were trained to support people safely. A staff member told us, “Yeah, in my company you don’t work until (you’ve) undergone certain training...” Staff had regular supervisions and spot checks undertaken to monitor that they were working in line with their training.

The provider undertook checks on potential new staff to the service. This included an overseas criminal records check. However, we also found that the provider had not ensured that all recruitment checks on new staff were robust. This included 2 reference letters with the date altered by hand, with no recorded explanation. A character reference submitted did not detail how the referee knew the person. Another staff member had a professional reference on file but no record in their application form of them working there. As such, this does not meet the required standard. New staff completed the care certificate training. However, other training certificates viewed, sometimes included up to 7 different topics trained in just 1 session. This increased the risk of training not being embedded. The registered manager when asked about staff training confirmed that they ran follow up sessions on training subjects that staff attended to help embed staff’s skills and knowledge. There were formal processes in place to monitor staff’s competencies in line with their training. Regular supervisions were held to enable staff to discuss their performance. People’s dependency levels were assessed to ensure there were enough skilled and knowledgeable staff to meet their needs. A computerised system monitored staffs timekeeping.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People who were supported with their medication by staff had no concerns. A person told us, “Yes they help, yes [they] give it to me according to my plan.”

Staff told us they had been trained to administer people’s medication who had been risk assessed as needing this assistance. A staff member confirmed to us, “Yes we have meds training, online at office and competency training as well.” Competency checks ensured staff were following their training and were carried out via a spot check. The registered manager told us staff underwent, “Training, practical training,” and that staff completed a, “Competency workbook.” They went on to say, “On top of that we do medication audits, make sure things reconcile. No one needs [as and when required] medication at the moment. We train the carers to always engage with the service user e.g. asking how their pain is, checking on a rash. We would put a chart in place and record how they feel that day. We complete a reconciliation of medication including when it's arrived, what's been taken, what's left. We need to read the notes in case (medication) is disposed of.”

People’s care records detailed how staff were required to support people with their medication. Staff knew the people they supported well, and people were supported by a consistent staff team. However, we found that sometimes staffs documentation of the support given was not always robust. Information around a person’s known medication risk was recorded in their care record, however, this had not been formally risk assessed.