Care 4U Services (Midlands) Ltd

People’s experience of using this service and what we found

People and relatives spoke positively about the service they received. Staff knew how to keep people safe and protect them from harm. Staff were recruited safely. Risks associated with people’s care and their home environments were identified, assessed and well managed. Staff were trained in medicine management and people received their medicine safely. The prevention and control of infections were managed in line with government guidance and the provider’s procedures.

People and their relatives had confidence in the ability of staff to provide effective care. Staff development was supported through an induction when they started work. Ongoing training was provided to the staff team to ensure their skills and knowledge remained up to date to provide effective care. People had access to healthcare professionals to ensure their ongoing healthcare needs were met.

People received person centred care and had developed positive relationships with staff. Staff had a good understanding of the care and support people needed and provided this safely with care and compassion. People’s right to dignity and privacy were respected and their independence was promoted.

Care plans were developed in partnership with people to ensure they reflected people’s preferences, religious and cultural beliefs and values. People and their relatives knew how to make a complaint. Feedback was welcomed and was used to drive forward improvements and learn lessons.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager had processes in place to monitor and review the quality of the service provided, for example, audits of care records. The provider had a contingency plan in place, to minimise any risks to the service running safely in the event of, for example adverse weather conditions. Staff felt supported by the registered manager who worked in an open and transparent way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 March 2021) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care 4 U (Midlands) Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service and what we found.

We received mixed feedback from people and their relatives about the care they received from Care 4U Services. Some people told us they were not confident concerns they raised would be listened to. People’s experiences of the quality of care were inconsistent.

The provider had taken action to improve staff training since the last inspection. However, some people still felt staff were not always confident or competent in manual handling techniques and supporting people to move safely. Other people gave positive feedback about their experiences, said they felt safe with staff and that staff appeared well trained. Staff received supervision and gave positive feedback about working for Care 4U Services.

Staff were trained in infection control and there were sufficient supplies within the office of PPE and hand sanitiser. However, people told us some staff were inconsistent in following infection control guidance to prevent the spread of infectious disease.

Risks to people were assessed but the level of detail contained in risk assessments and care plans was varied. The registered manager acknowledged the gaps in some risk assessments and care plans and took immediate action when this was raised by implementing new risk assessments and updating people’s records.

Information about people’s medication was documented and there were protocols for people who needed ‘as required’ medication. Staff were trained in safeguarding and understood their responsibility to report any concerns, accidents or incidents about people to the registered manager.

The provider had not consistently demonstrated that they notified CQC of incidents that occurred at their service as they were supposed to. Improvements were still required in how the provider monitored the quality of care people received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 9 September 2020) with identified breaches of the regulations in Staffing and Good Governance. The provider has existing conditions placed on their registration to complete improvement actions and report their progress to CQC. The provider completed updates to their action plans and shared these with CQC in line with the conditions on their registration. However, at this inspection not enough improvement had been made to remove these conditions, and the provider was still in breach of regulations.

Why we inspected

This inspection was prompted by concerns we had received about the standards of care at the service, and failure to maintain good infection control procedures. As a result, a decision was made for us to inspect and examine those risks. We undertook a focussed inspection to review the key questions of Safe and Well Led. The overall rating of this service has remained as requires improvement. This is the second time the service has been rated as requires improvement.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. It does not cover legal requirements in relation to the other three Key Questions and therefore the provider remains in breach of Regulation 18 (Staffing) which was previously reported in the Key Question Effective.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care 4U Services (Midlands) Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service and what we found

We received mixed feedback from people and their relatives about the care they received from Care 4U Services. The provider had taken action to improve staff training since the last inspection. However, some people still felt staff were not always confident or competent when supporting them using specialist equipment, such as hoists. Other people gave positive feedback about their experiences, said they felt safe, that staff appeared well trained and had noticed improvements since the last inspection.

Staff were trained in safeguarding and understood their responsibility to report any concerns, accidents or incidents about people to the registered manager. However, staff did not understand the role of the local authority in responding to safeguarding concerns and did not know who to report concerns to outside of Care 4U Services. We raised this with the provider who said they would take action to address this and improve staff knowledge and understanding.

Since the last inspection the provider implemented an electronic risk management and care planning system. Risks to people were assessed but the level of detail contained in risk assessments and care plans was varied. The registered manager acknowledged the gaps in some risk assessments and care plans and took immediate action when this was raised by implementing new risk assessments and updating people’s records.

Information about people’s medication was documented and there were protocols for people who needed as required medication. However, more detail was needed to ensure these were given safely and consistently by staff.

Staff were trained in infection control and there were sufficient supplies within the office of PPE and hand sanitiser. Staff were reminded of the importance of following good infection control practices. However, we received some feedback from people that staff were not always following these guidelines and had to be reminded before caring for people.

The provider had a system to respond to complaints. Whilst we found actions were taken to address people’s complaints and concerns, not all people spoken with had confidence in the complaints process as some of their concerns about staff practice continued. A new electronic system to record and monitor complaints was in the process of being implements.

Staff received supervision and gave positive feedback about working for Care 4U Services. People received regular reviews of their care and knew who to speak to if they wanted to raise concerns or make a complaint.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 28 December 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of regulations 12 (Safe care and treatment), 13 (Safeguarding service users from abuse and improper treatment) and 19 (Fit and proper persons). However, enough improvement had not been sustained in their overall quality assurance processes and the provider remained in breach of Regulation 17.

This service has been in Special Measures since 4th December 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an unannounced comprehensive inspection of this service between 9th October 2019 and 18th October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment, Safeguarding service users from abuse and improper treatment, Good governance, Fit and proper persons employed and Staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. It does not cover legal requirements in relation to the other three Key Questions and therefore the provider remains in breach of Regulation 18 (Staffing) which was reported in the Key Question Effective after the last inspection.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care 4U Services (Midlands) Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Care 4U Services (Midlands) Ltd is a domiciliary care service providing personal care to people with a mixture of needs including, dementia, physical disabilities and sensory impairments. People are supported in their own homes, at the time of the inspection 76 people were receiving personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

At our last inspection the registered manager had failed to ensure recruitment was done in a safe way, we found serious concerns with recruitment at this inspection. Care and treatment was not provided in a safe way. People were not protected from potential harm and abuse. Medicines were not managed safely.

The provider’s systems failed to identify that care and treatment was not provided in a safe way. Audits did not identify serious concerns with recruitment and numerous other areas. Some people, staff and relatives did not know who the registered manager was. Staff did not always feel listened to by the management team. People were not always given the opportunity to feedback about their care.

Staff had not completed the training required to do their job. People’s specialist diets were not safely managed. People’s needs were not thoroughly assessed. Some people said they did not have an up to date care plan. Staff understood their responsibilities in relation to mental capacity and gaining consent from people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care plans did not demonstrate people had been involved in planning their care. There was no evidence in people care plans that they had had a review. Staff did not always treat people with dignity and respect. There were mixed opinions from people as to whether staff were caring.

People’s preferences about how they wanted to be supported were not always considered. Details about how people may want to be supported with their religion were not always recorded. There were mixed opinions from people about whether they knew how to make a complaint. People’s end of life preferences were not documented.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 03 April 2019) and there was a breach of one regulation. At this inspection the service had deteriorated, and improvement had not been made. The provider was now in breach of multiple regulations.

Why we inspected

The inspection was prompted in part due to whistleblowing concerns and concerns received about safeguarding and recruitment. The information CQC received about the incidents indicated concerns about the management of safeguarding processes and staff recruitment processes. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make significant improvements. Please see all sections of this full report. The provider has taken some action to mitigate the risks identified at inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, good governance, staffing and staff employment at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This service is a domiciliary care agency which provides personal care to people living in their own homes. At the time of our visit 42 people were being supported with personal care.

People’s experience of using this service:

At the last inspection visit we made a recommendation to improve recruitment processes within the service. At this inspection we found the registered manager had not acted upon the advice and consistently implemented safe recruitment processes. We looked at the recruitment of four members of staff and found appropriate checks had not been followed. Two records did not have a full employment history on their application form. There was no evidence this had been discussed at interview or a satisfactory written explanation sought.

The registered provider used a variety of methods to assess and monitor the quality of the service. However, we found auditing systems were not always effective and had failed to identify concerns regarding the safe recruitment of staffing. Recruitment file audits had taken place but had not identified the concerns we found.

People told us they felt safe with the support they received from the staff. People told us they were supported by staff who knew and consistently met their needs. Staffing levels were reviewed to ensure there were enough staff to provide a flexible and responsive care.

Staff were aware of their responsibilities in reporting and responding to abuse and said they would not hesitate in reporting any unsafe or abusive practice. Staff told us the registered manager understood the importance of creating a culture where people were free from abuse and harassment.

People’s care and support had been planned in partnership with them. People felt consulted and listened to about how their care would be delivered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and relatives told us they were more than happy with the service provided. They told us staff were committed, kind, caring and reliable.

People said they were consulted with about all aspects of their care and support. They said they could raise any concerns with the management team and were confident they would be dealt with professionally and in a timely manner.

People said they received effective health care with positive outcomes. They said the staff at the service liaised with health professionals to ensure their health needs were met. We saw evidence of multi-agency working to meet people’s health care needs.

When people required support with managing their medicines we saw good practice guidance was followed.

Rating at last inspection:

At the last inspection visit the registered provider was rated good. The report was published 04 May 2016.

Why we inspected:

This was a planned and scheduled inspection.

Enforcement:

Please see the action we have told the provider to take’ section towards the end of the report.

Follow up:

We have requested an action plan from the registered provider as to how they plan to address the breach in regulation and make improvements to the service.

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We considered all of the evidence we had gathered under the outcomes that we inspected. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people's individual needs had been assessed and that there were enough suitably trained staff to support and care for people.

People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

We saw that when people needed help and support taking their medicines systems were in place that ensured this was done safely.

The provider had arrangements in place to deal with out of hours emergencies. This meant that people would always be able to get the support they needed when the office was closed.

The manager regularly monitored the quality of the service to ensure it was safe.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. People said that their care plans were up to date and reflected their current needs.

It was clear from speaking with staff they had a good understanding of people's care and support needs and they knew them well. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

Is the service caring?

We spoke with three people being supported by the service and three relatives. We asked them for their opinions about the staff that supported them and their family members. Feedback from people was positive. One person told us, "I always know I'm going to get my night care, they always arrive." Another person said, "We work everything between us. I am involved in every aspect of my care" One relative told us, "We are really pleased and happy with them."

When speaking with staff it was clear that they genuinely cared for the people they supported.

People who used the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that people's care plans and risk assessments were reviewed on a regular basis to ensure that their changing needs were planned for.

People knew how to make a complaint if they were unhappy. They were confident that if they raised any issues with the manager of the service they would be addressed. One person told us, "They are excellent sort things out straight away.'

Is the service well-led?

The registered manager had been in post some time. It was clear from our discussions with the manager they were experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

There was a system in place to monitor the quality of the service provided to ensure it was safe.

People told us that they were happy with the quality of care provided and that it made a positive difference to their lives. They told us that care and support was provided that met their care and support needs. A relative told us 'Carers don't rush and they always stay the correct length of time.'

People using the service had opportunities to express their views about the service they received from the provider. They told us that they were involved in the planning of their care and support needs. This was so that they could maintain their preferred daily routines.

People told us that staff had a good understanding of their care needs and that they supported them in a safe and respectful manner. A person using the service told us 'I am very happy with the agency. They have never let me down. I feel very blessed that the agency staff have been so caring. They have walked in snow and ice to get to me.'

People told us that they were confident that they could raise concerns if they were not happy with the care and support they received. A person using the service told us 'I made a complaint a few years ago and the agency dealt with it very quickly and appropriately.'

Effective arrangements were in place for the recruitment and selection of new staff. People using the service were in involved in this process. This meant that they had a choice of who supported them.