The Caring Choice Limited

The Caring Choice Limited is a domiciliary care service which provides personal care to people in their own homes. The service mainly provides support to older people. At the time of our inspection there were 28 people using the service.

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 receive personal care, we also consider any wider social care provided.

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

People were happy with the care and support they received. People were supported by staff who knew them well and had developed positive relationships with them. Staff respected people’s preferences and treated people with dignity and respect.

People felt safe when receiving care from the service. Some improvements were needed to ensure all risks to people were thoroughly assessed and mitigated. We have made a recommendation about risk assessment and management. Accidents and incidents were managed appropriately.

There were enough staff to meet people’s needs at the right time. Staff turned up on time and delivered personalised care to each person. People received effective support with their medicines and there were suitable measures in place to prevent the spread of infections.

People’s needs were assessed to check the service was suitable for them. People were involved in this process and they were supported to remain involved in decisions about their care. 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.

Without exception, everyone told us the staff were kind and caring. People and their relatives described how staff were very good at communicating with them. The service was responsive to people’s needs and flexible if any changes were needed. People and their relatives knew how to complain or raise any issues about the service, if they needed to.

The service was managed by an experienced registered manager. Everyone told us the service was well-organised. Staff were supported to deliver high-quality care through training, spot checks and supervision. The registered manager and senior staff completed a range of checks on the quality and safety of the service to identify any areas where it needed to improve.

The service had an open, transparent culture. Staff enjoyed their jobs and were all keen to deliver a person-centred service. Staff worked alongside other professionals to help ensure people received effective care and support.

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 requires improvement (published 31 May 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made a recommendation about risk assessment and management.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Caring Choice Limited is a domiciliary care service which provides personal care to adults with a range of support needs in their own homes.

The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’. Where they do we also take into account any wider social care provided. The Caring Choice Limited was providing personal care to thirty five people at the time of the inspection.

At the last inspection on 7 and 8 November 2018 we found the service to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 13, Safeguarding service users from abuse and improper treatment; Regulation 12, Safe care and treatment; Regulation 18, Staffing; Regulation 17, Good governance; Regulation 16, Receiving and acting on complaints; Regulation 19, Fit and proper persons employed. The overall rating for the service was Inadequate and the service was placed in Special Measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that significant improvements had been made and it is no longer in breach of the regulations, rated as Inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures.

People’s experience of using this service:

People’s medicines were now managed safely, however we recommend the provider and manager refer to current guidance regarding providing information for care workers on what each person’s medicines are prescribed for, and guidance on when a person may need their ‘as and when required’ (PRN) medicines.

Staff were now provided with an effective induction and relevant training to make sure they had the right skills and knowledge for their role. Staff were supported in their jobs through regular supervisions and an annual appraisal. However, the manager did not receive formal supervision or have an annual appraisal. The provider told us they would start doing this.

We saw people or their representative had signed their consent to receive care and support form the service on their care records, however there was no evidence on file that the nominated person had the legal authority to do this. We recommend the provider and manager consult current guidance on how best to ascertain and record this information.

Every person now had a care record in place which reflected the person’s current health and social care needs. The provider and manager agreed further work was required on people’s care records to ensure all the information recorded was person-centred.

People had the same group of care staff visiting them at home. However, some people told us they would like to know in advance who would be coming each day. The provider and manager they told us they would email or post people their staff rota the week before, if requested.

There were now systems in place to monitor and improve the quality of the service provided. People were asked for their opinion of the quality of the service via review meetings. Staff were asked via regular team meetings and an employee satisfaction survey. These systems need to be further developed and sustained over time.

There were enough staff available to ensure people’s care and support needs were met. The registered provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background.

There were systems in place to recognise and respond to any allegations of abuse. Staff had received training in this area.

People were consulted and listened to about their care and support needs. People were supported to have maximum choice and control of their lives.

People were supported to eat and drink to maintain a balanced diet, where required. People were supported to maintain good health and have access to health and social care services as required.

Positive and supportive relationships had been developed between people, their relatives, and staff. People told us they were treated with dignity and respect.

People’s care and support was planned and delivered in a way that ensured it met their needs and reflected their preferences.

There were systems in place to respond to complaints. People told us they knew how to complain, and the manager and senior care staff were responsive to any concerns they raised.

The provider had recently purchased a comprehensive set of policies and procedure relating to all aspects of service delivery. Staff could access these via an app on their mobile telephones or look at paper copies held in the office.

Rating at last inspection:

At the last inspection the service was rated Inadequate (report published on 11 January 2019).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

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

The Caring Choice Ltd is a domiciliary care agency. It provides support to people living in their own houses and flats in the community. Not everyone using The Caring Choice Ltd receives support with the regulated activity of ‘personal care’; The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At time of this inspection The Caring Choice Ltd was providing support to 41 people.

At our last inspection on 10 and 13 November 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulation 17, Good governance, Regulation 18 Staffing and Regulation 19, Fit and proper person employed. The overall rating of the service was requires improvement.

Following our last inspection the registered provider sent us an action plan with details of the improvements they planned to make to meet the requirements of the regulations. At this inspection we found that sufficient improvements had not been made and the registered provider remained in breach of these three regulations. We also found three further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were; Regulation 12, Safe care and treatment; Regulation 13, Safeguarding service users from abuse and improper treatment; and Regulation 16, Receiving and acting on complaints.

The overall rating of the service is inadequate and the service is in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There was a manager at the service, but they were not registered with the CQC. The nominated individual (representative of the registered provider) told us the manager had applied to be registered. A registered manager is a person who has registered with the CQC 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.

Staff recruitment procedures were not safe. Relevant checks had not always been completed to ensure staff were suitable to work in the care profession.

Medicines were not managed safely. People’s medicine administration records (MARs) were not always up to date. Staff competencies in medicines management were not regularly checked.

The registered provider did not have adequate systems in place to ensure people were protected from abuse.

Staff had not received regular supervisions or annual appraisals which meant their performance was not formally monitored and areas for improvement may not have been identified.

Some staff training was overdue so staff had not been supported to maintain and update their skills and knowledge.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. There were no records of any care staff undertaking mental capacity training. However, staff spoken with were clear on the importance of involving people in making decisions. We recommend the registered provider considers providing training for staff on the Mental Capacity Act.

People’s privacy was not always respected. This was because the registered provider shared a reception area with another organisation.

Four people did not have a written care record in place. This would have included risk assessments, which would have given staff information on how to reduce any risks to the person. Where people had care plans and risk assessments in place these had not been reviewed since the registered manager left the service in July 2018.

The registered provider had a compliments, comments and complaints policy and procedure in place. However, the registered provider did not have an effective system in place for identifying, receiving, handling and responding appropriately to complaints and comments made by people or persons acting on their behalf.

The registered provider had not ensured there were effective systems in place to monitor and improve the quality of the service provided.

The service had policies and procedures in place. However, they had not been reviewed and therefore may not have represented the most up to date legislation and good practice guidance.

People and their relatives told us the staff were kind and caring.

Staff told us the manager and nominated individual were approachable and supportive.

During this inspection we found a total of six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

There was a manager at the service who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

The Caring Choice was registered with the CQC on 1 December 2016. This was the service’s first inspection.

The inspection took place on 10 and 13 November 2017. We gave the registered manager 48 hours notice of our inspection to make sure the registered manager, some staff and some people receiving support would be available to meet and speak with us.

People spoke very positively about the support provided to them. They told us they felt safe and their health support workers were respectful and kind.

We found there were some systems in place to protect people from the risk of harm. Staff we spoke with were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people, and management plans to reduce the risks were in place to ensure people's safety.

We found some systems were in place to make sure people received their medicines safely so their health was looked after. However, staff had not completed appropriate training with this service to make sure they had relevant and up to date skills.

Staff recruitment procedures were not robust to ensure people’s safety was promoted.

There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff were not provided with relevant training so they had the skills and knowledge they needed to undertake their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice. People had consented to receiving care and support from The Caring Choice.

Visit times were flexible to support people’s access to health professionals to help maintain their health.

People were supported to maintain a healthy diet which took into account their needs and preferences, so their health was promoted and choices could be respected.

Staff knew the people they supported very well. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

People said they could speak with their health support workers or the registered manager if they had any worries or concerns and they would be listened to.

There were some systems in place to monitor and improve the quality of the service provided. Checks and audits had not been recorded to evidence they had taken place and to assist in identifying any trends or patterns to make sure full and safe procedures were adhered to.

At this inspection, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulation 17, Good governance, Regulation 18, Staffing and Regulation 19, Fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report.