We carried out a review of the data available to us about County Carers Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about County Carers Limited, you can give feedback on this service.
County Carers Limited is a domiciliary care agency providing personal care to people in their own homes. The service supports older people, people living with dementia and people with a physical disability. At the time of our inspection the service was providing personal care to 54 people.
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 this service and what we found
Staff understood their responsibilities to protect people from harm and knew how to raise safeguarding concerns. People’s care plans contained detailed risk assessments with specific instructions for staff about how to safeguard people from identified risks.
The registered manager had completed the necessary safe recruitment checks to ensure they employed suitable staff.
There were enough staff to meet people’s needs and provide safe care. People were supported to take their medicines by suitably trained staff. People were protected from the risk of getting an infection by trained staff.
The registered manager and senior staff team were committed to providing individualised, safe care. They maintained a detailed oversight of quality and safety in the service through completing a series of effective checks and audits.
People felt staff and the management team were competent and approachable. They told us they felt comfortable raising any queries or concerns.
Staff reviewed their practice to make improvements and worked effectively with health and social care professionals.
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 08 November 2019) and there were two breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an announced, comprehensive inspection of this service on 08 November 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 to comply with the regulations ‘good governance’, and ‘fit and proper persons employed’.
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.
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 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 County Carers Limited 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.
County Carers Ltd provides domiciliary care services to people within their own homes. This can include specific hours of required support or live in carers to help promote the person's independence and well-being.
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. At the time of our inspection the service was providing personal care to 45 people.
People’s experience of using this service and what we found
Recruitment processes were in place however they were not as robust as they should be, to ensure as far as possible, that people were protected from staff being employed who were not suitable.
The registered person did not use their quality assurance systems to monitor the running of the service, ensuring appropriate records were in place and ensure compliance with all the fundamental standards.
The registered person did not always maintain clear and consistent records to show their Duty of Candour responsibility was applied as per regulation.
People were protected from the risks of abuse and said they felt safe with the staff providing their support and care. The registered manager had the knowledge to identify safeguarding concerns and acted on these appropriately. Risks to people’s personal safety had been assessed and plans were in place to minimise those risks. Staffing levels supported people to stay safe while living as independent a life as possible. The registered manager scheduled visits, so the same staff went to see people to maintain continuity of care and support. People were informed about the changes to their visits as necessary. Medicines were handled correctly and safely.
People felt they received effective care and support from staff who knew them well and were well trained. The staff monitored people's health and wellbeing and took appropriate action when required to address concerns. People's rights to make their own decisions were protected. 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.
People were treated with care, respect, kindness and their dignity were upheld. This was confirmed by people and their relatives who provided feedback. People were consulted about their care and support and could change how things were done if they wanted to. People's diverse needs were identified and met and their right to confidentiality was protected.
People confirmed they received care and support that was personalised to meet their individual needs. The registered manager and staff worked well together for the benefit of people and were focused on the needs of the people using the service.
The registered manager praised the staff team for their hard work and appreciated their contribution to ensure people received the best care and support. People benefitted from receiving care from staff who were happy in their work and felt well managed and supported. The registered manager encouraged feedback from people and families, which they used to make improvements to the service and protected people against the risks of receiving unsafe and inappropriate care and treatment.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 27 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to regulation 17 and 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. Staff recruitment was not always robust; effective systems and governance overview were not used to ensure the service met the required fundamental standards of care.
You can see what action we have asked the provider to take at the end of this full report.
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.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People and their relatives advised that they had been appropriately involved in the planning and reviewing of care. They felt that the service excelled at providing exceptional responsive care to people, often going above and beyond what was expected of them. Care plans were thorough providing specific details on how to support people in the way they wanted. This allowed people to remain involved in the how they had care delivered effectively.
People told us that they felt safe. Staff were able to explain signs of abuse and what protocols they would follow if they suspected anything. The service had systems in place to ensure sufficient suitably qualified staff were employed to work with people. They were matched to meet people’s needs, in terms of language, knowledge, likes and dislikes.
People received care and support from staff who had the skills and knowledge to care for them. All staff received a comprehensive induction, training and support from experienced members of staff. Bespoke training was being delivered to meet the changing needs of people, whilst ensuring that staff remain up to date with changing legislation and guidance on best practice. Staff reported feeling supported by the registered manager and said they were listened to if they raised concerns.
People who could not make specific decisions for themselves had their legal rights protected. People’s care plans showed that when decisions had been made about their care, where they lacked capacity, these had been made in the person’s best interests. Staff had an understanding of the Mental Capacity Act, and used the principles of this when working with people.
People felt the service was respectful and preserved their dignity and independence. Where possible choice was given and the person was encouraged to complete tasks independently. This promoted well-being for the person.
People were supported with their medicines by suitably trained, qualified and experienced staff. Details were provided on each person’s file on what the medicine was for and how this needed to be administered. Comprehensive protocols for PRN medicines were recorded in the files, where applicable to prevent over usage. PRN medicines are used on an as needed basis.
People told us communication with the service was good and they felt listened to. People, professionals and relatives said they thought people were treated with respect, preserving their dignity at all times. County Carers was described by a relative as “one of the best companies out there”.
The quality of the service was monitored regularly by the registered manager, who is also the nominated individual. A thorough quality assurance audit was completed bi-annually with an action plan being generated, although this was not always followed up on, or evidenced. The bi-annual audit gathered information from people, relatives and staff to better the service. The registered manager advised shorter audits were completed monthly, although a formal report was not always prepared. Feedback was encouraged from people, visitors and stakeholders and used to improve and make changes to the service. We found evidence of compliments. No complaints had been received, however the registered manager was able to describe what process would be taken should this happen.