CareService24

CareService24 is a domiciliary care agency. It provides personal care and support to people living in their own homes. Not everyone who used the service received personal care. At the time of this inspection 78 people were receiving the regulated activity of personal care from the service. 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

Improvements had been made by the provider which ensured risks to people’s health and safety were fully assessed. Systems and processes had been improved to ensure the provider had effective governance and oversight of the service.

People had detailed pre -assessments and risk assessments completed for them. These were then used to develop person centred care plans which guided staff on how to care for people safely. Care plans were detailed and regularly updated to ensure people received effective care and support.

Staff received the training they needed to support people safely and liaised with health and social care professionals if they needed further guidance regarding people’s health.

Robust recruitment practices were followed. Appropriate checks were completed to ensure only suitable staff were employed. There was an ongoing process of staff recruitment to ensure people were supported safely and effectively. Staff received an induction and were well supported through a programme of regular supervision, spot checks and training.

People and their relatives told us they were happy with the support they received from CareService24. People told us they liked their care staff and looked forward to their visits. People were kept informed of any changes and felt involved in their care. Staff knew people well and understood how they preferred their care and support to be delivered.

People were protected from abuse and avoidable harm. People felt safe with staff, who had the appropriate training and skills to provide care safely and effectively.

Medicines were managed and administered safely. People were supported to take their medicines by staff who had received training to administer medicines.

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 received personalised care which was responsive to their individual needs. Staff had a good understanding of the care and support people needed and provided this with kindness and care, whilst respecting their privacy and dignity. People received their care from a small, consistent team of care staff who knew people’s care and support needs well.

The service involved people and their families in decisions about people’s day to day care and support needs. Relatives and people felt listened to and were consulted about how they preferred to receive their care and support.

People felt the service was well led, friendly and professional. Staff felt very well supported in their roles and spoke positively of the supportive and open approach taken by the management team.

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 10 January 2022).

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 the provider had made the required improvements and was no longer in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 18 November 2021. 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. At our last inspection we found breaches in relation to safe care and treatment, and systems to manage the service.

We undertook this focused inspection to check the service 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, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. 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 CareService24 on our website at www.cqc.org.uk.

Follow up

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

CareService24 is registered to provide personal care to people in their own homes. At the time of the inspection 136 people used the service. The registered manager told us the service had a contract to support people being discharged from hospital as part of the COVID-19 pandemic response.

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

Risks to people were not always assessed in a timely way before the service started supporting them. The lack of timely risk assessments placed people at risk of harm. This also meant staff were not fully aware of how to support people to mitigate the risks in their lives.

Management systems did not always operate effectively.

These concerns resulted in breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in safe care and treatment and the governance of the service.

People did not always have care plans in place at the time their care started. This made it more difficult for staff to support people effectively.

We have made a recommendation about people having timely assessments.

Staff understood their responsibilities with regards to infection prevention and control. People told us staff always wore the required equipment during visits in line with current government guidance.

Staff had supervision which included reflective questions to help improve their understanding in areas such as safeguarding, medicines and dementia care. People gave examples of where the service had made a positive difference to their lives.

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 his practice.

The service understood the importance and benefits to people of timely referral to health and social care professionals. The service had supported staff to access specialist training which had helped them provide improved care for people with particular health needs.

The registered manager understood the importance of valuing the staff and praising them for their hard work during the COVID-19 pandemic. The service kept a record of compliments from people and relatives which were shared with staff.

Almost unanimously the registered manager was seen as approachable, supportive, receptive and motivated to drive improvement. They were well supported by the provider.

The service worked well with other agencies and understood its role in the wider health and social care system. The service had liaised with an ambulance trust to introduce and train staff in the use of specialist equipment used to support people following a fall. This had helped to reduce pressure on the NHS.

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 24 October 2018).

Why we inspected

We received concerns in relation to the assessment and management of risks in people’s lives. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

The inspection was also prompted by notification of a specific incident. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safe care and treatment and good governance.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for CareService24 on our website at www.cqc.org.uk.

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.

This announced inspection site visit activity started 28 June 2018 and ended 29 June 2018. During this comprehensive inspection we found improvements had been sustained and made in all of the five domains.

The manager was in the process of registering with the CQC, and had undergone their ‘fit person’ interview on the 26 June 2018. The manager was registered on the 5 July 2018. 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.

The manager knew people's needs well and were prominently involved in the day to day running of the service.

Staff understood about people's preferences, routines and the support they needed to maintain their independence and remain living in their own home.

Risks to individuals were assessed and monitored. When incidents took place, the manager reflected on the events to ensure learning was embedded for future practice. This included sharing experiences in staff meetings and during supervision of staff.

Appropriate checks were made before staff started to work to make sure they were suitable to work with people.

People were supported by staff who were described as being, “Kind, caring and respectful.” Staff told us they felt supported in their roles and had received training that provided them with the necessary knowledge and skills.

Staff understood the need to gain consent and followed legislation designed to protect people's rights and freedoms. Staff understood people's individual needs and were able to make adjustments to ensure these needs were met.

There was a complaints policy in place which people felt comfortable using if they had concerns.

Management and quality assurance systems had been devised and were in place to drive continuous improvement and the service.

We undertook an announced focused inspection of CareService 24 on 13,14,15 and 18 December 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in May 2017 had been made. We inspected the service against two of the five questions we ask about services: is the service safe and is the service well led, because the service was not meeting some legal requirements. No risks, concerns or significant improvements were identified in the remaining Key Questions through our on going monitoring or during our inspection activity so we did not inspect them. The ratings for the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. We gave the provider one day's notice of the inspection to be sure the people we needed to speak with would be available.

There was an acting registered manager in place who was in the process of applying to be registered. 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.

At the last inspection in May 2017 the service was not meeting the requirements of the regulations. We identified a breach in the regulations relating to safe care and treatment. People had not been protected against the risks associated with the unsafe management and use of medicines and CQC took enforcement action. Following that inspection the provider sent us an action plan that stated the changes and improvements they would make in order to meet the regulation by 30 September 2017. At this inspection we found that the service was compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were clear systems in place to ensure people received their medicines as prescribed. People were protected against the risks associated with the unsafe management and use of medicines.

People’s risks were assessed and care and support plans developed to ensure care was provided safely. Accidents and incidents were recorded, reviewed and analysed to ensure any trends were identified to enable action to be taken to safeguard people.

There were robust recruitment processes in place. Checks were completed on staff before they were employed to work with people, this showed staff were suitable for their role with people being supported by staff who had been safely recruited.

There were sufficient staff with the right skills and knowledge to care for people safely. People spoke positively about the care staff and looked forward to their visits.

Staff spoke knowledgably about infection control practices and had plentiful supplies of personal protective equipment.

People and staff spoke positively about the culture of the service which they described as open, supportive and honest. People felt there was a clear management structure in place with staff that listened to people and gave clear guidance and support.

CareService 24 provides personal care and support to people who live in their own homes in Bournemouth and the surrounding areas. At the time of our inspection they were providing personal care and support to over 60 people.

The service had a registered manager, as required by law. 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.

At the last inspection in January 2016, we asked the provider to make improvements to how medicines were managed. Following that inspection, they sent us an action plan that stated the changes they would make in order to meet the regulation by 18 April 2016. However, at this inspection we found that medicines were still not managed safely. Responsibilities for ordering and administering medicines were not set out clearly in people’s care plans. There were frequent occasions where people had run out of their prescribed medicines. Medication records were incomplete and staff did not always have clear instructions for how and when to administer prescribed skin creams or ‘as required’ medicines.

Some people’s assessments and care plans did not clearly address needs that should have been identified and planned for. For example, care plans did not always mention significant health conditions such as diabetes. Consequently, there was no guidance for staff to provide the appropriate support and recognise when a person might be becoming unwell. There was not always sufficient, up-to-date information regarding people’s moving and assisting needs.

Whilst the people we spoke with were positive about their care, others did not always get the care and support they needed.

The provider’s quality assurance processes were not effective. Audits had not detected the significant issues we found in relation to medicines, care planning and delivery of care. There had been changes in office staff since the last inspection; the office had been fully staffed for only three weeks since the last inspection. Supervision and spot checks of staff had fallen behind. Complaints and safeguarding concerns had not been collated to identify themes for learning. Reasons for staff leaving employment were not systematically recorded and analysed.

People told us their staff were kind and compassionate. They said they were treated with respect and that their privacy and dignity were preserved. However, when we entered the flat of someone we were visiting they were in their bedroom with the door open, in a state of undress midway through personal care. The staff who were providing care did not encourage the person to maintain their dignity. Some people could not recall having been asked about their preference for care workers of a particular gender and some said they would have liked a choice. The registered manager stated that gender preference was always asked at the start of a package of care but was unable to provide evidence of this.

Some people talked about having regular staff who knew them well, whereas others reported frequently changing staff. The service had recently updated their computer system to help the allocation of regular staff to people’s care calls.

Some had had experiences with staff who arrived wearing dirty uniforms and smelling of tobacco. The registered manager told us they had already identified this as an issue and had addressed this with the staff concerned.

The staff we spoke with were positive about how they were supported. They were confident that they could approach the management team with any concerns and felt they had received suitable training to carry out their role. Staff training in essential areas such as moving and handling, medicines administration and infection prevention were up to date.

You can see what action we asked the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

CareService 24 provides personal care and support to people who live in their own homes. At the time of our inspection they were providing support to over 60 people.

The service is required by law to have 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. CareService24 had a registered manager but they had left their post several months before and had not yet applied to cancel their registration. There was a replacement manager in post and they had applied to register.

People and relatives were very positive about the service they received, stating that staff were caring, treated them with dignity and did what was expected of them. Comments included: “They know what I want and I know how they will respond” and “I know they can do their job in a professional way”. Some people reported that on occasions staff were delayed and that they were not always notified of this. The management team had identified this as a concern and were monitoring staff timesheets closely, taking action when they found discrepancies.

People said their staff always provided the support they needed and that they felt safe with them. Staff, including the office staff, knew people well and understood their needs. Care plans were easy to follow with sufficient detail in most respects. The extent of detail in relation to moving and handling depended on the detail in occupational therapists’ moving and handling assessments and plans. We recommend that the service reviews the level of detail it requests from professionals in order to include sufficient detail regarding moving and handling, such as which sling to use and how to attach it, in people’s care plans.

People received care from staff who were well supported through supervision and training.

People knew how to raise concerns and complaints and records showed that these were investigated and responded to. Staff understood how to protect people from possible abuse and how to blow the whistle about wrongdoing or poor practice.

People were protected against abuse. Staff had knowledge and confidence to identify and report signs of abuse. Safe recruitment practices were followed before new staff were employed to work with people, including references and criminal records checks.

Medicines were not always managed safely. Topical medicines, such as creams or drops prescribed to treat skin, eye or ear conditions did not have clear instructions for administration or consistent records of when they were applied. They did not appear in medicines administration records. Medicines administration records were handwritten by staff but were not always signed by the person who created them, nor countersigned by another person who had checked they were written out correctly. You can see what action we told the provider to take at the back of the full version of the report.

Quality assurance systems, such as audits of records and medicines charts and surveys of people using the service, were being implemented to monitor the quality of care and support that people received. There was an improvement action plan that had been drawn up since the appointment of a replacement manager in November 2015. This was in response to shortfalls identified in a contract monitoring visit, and also by a mock inspection by an external consultancy. The action plan addressed matters that we identified during this inspection.

We looked at a total of five care plans and visited two people in their home. Both of these people were happy with the service provided and said they had, "No complaints". We saw they were involved in the assessment and care planning process. Their views on how support should be given and at what times had been taken into consideration when visits were organised.

We found that the person's plan clearly set out how support should be provided and included details of what they were able to do themselves. People confirmed support was given as detailed in their plan.

Staff were recruited effectively, with relevant checks being carried out prior to an employee starting work. References had been obtained from previous employers when staff had worked in care settings.

Care workers were organised in teams to provide consistency of care and there were sufficient numbers available to support people.

All staff were given induction training, which they confirmed met their needs and enabled them to support people appropriately. The provider was in the process of developing on-going training to ensure staff were competent to carry out their role.

The provider had a statement of purpose that set out the aims and objectives of the service, the regulated activity and type of service provided.