Source · CQC inspection
Shining Star Home Care Limited
Type Social Care Org
Region West Midlands
Last inspected 5 Apr 2023
Overall rating: Requires Improvement View full CQC report
Domain ratings
Safe
Requires Improvement
Effective
Good
Caring
Good
Responsive
Good
Well-led
Requires Improvement
Earlier inspection findings
Must-do actions (1)
Must-do action 1 of 1
Must do
Well-led
The providers governance systems and processes required strengthen.
Should-do actions (14)
Should-do action 1 of 14
Should do
Safe
Improvements were needed in the providers systems to ensure the CQC were notified of events around allegations of abuse.
Should-do action 2 of 14
Should do
Safe
Improvements were needed in how people's relatives and health and social care professionals were involved with the assessment and ongoing monitoring of how people's care was supported and managed.
Should-do action 3 of 14
Should do
Safe
Improvement was required in care documentation. People and relatives told us there was no accessible information which demonstrated what care had been agreed and how staff were to support them to keep them safe. People and relatives also told us staff did not record what care they had provided at each call.
Should-do action 4 of 14
Should do
Safe
Paper records did not contain detailed information to guide staff on how to manage risks associated with people's care.
Should-do action 5 of 14
Should do
Safe
Detailed care plans are required should the current staff became unwell and agency staff are needed. Clearer guidance would be needed for them to meet people's needs safely and consistently.
Should-do action 6 of 14
Should do
Safe
Improvements were needed in the record keeping of medicines which were administered to people.
Should-do action 7 of 14
Should do
Safe
Improvements were required in the safe recruitment of staff. Staff files did not hold the relevant information to demonstrate that staff had been safely recruited.
Should-do action 8 of 14
Should do
Safe
Improvements were required for staff's schedules, so the provider could be assured staff were attending calls in line with the person's time preference.
Should-do action 9 of 14
Should do
Responsive
The provider had not considered how a range of communication tools and aids were to be used to support effective communication with individuals and ensure they had information in a way they could understand.
Should-do action 10 of 14
Should do
Well-led
The provider should ensure that systems for communication and record keeping needed to be more robust, to ensure important information did not become lost.
Should-do action 11 of 14
Should do
Well-led
There were gaps in the providers knowledge of when notifications were required to be submitted. We found that allegations of abuse notifications had not been submitted, as the provider's knowledge of when these types of notification should be sent was lacking. We have sign posted the provider so they can update their knowledge.
Should-do action 12 of 14
Should do
Well-led
There is a requirement on provider's to complete the Provider Information Return (PIR) when requested to do so. The PIR request was sent to the provider on 20 April 2022. No completed PIR was returned to the Care Quality Commission.
Should-do action 13 of 14
Should do
Well-led
Improvements were required to ensure the provider worked in partnership with external agencies and relatives to ensure people received a holistic service.
Should-do action 14 of 14
Should do
Well-led
Further consideration should be taken as to how the provider makes this information accessible to people and involve them in the planning of their care.