ICare (GB) Limited-Knowsley

ICare (GB) Limited-Knowsley provides support and/or personal care to people living in their homes. 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 there were 85 people receiving support with personal care.

People's experience of using the service and what we found

We could not always be assured that people were receiving their medicines as prescribed. Staff had not always recorded the times they had administered some people's time-sensitive medicines, such as paracetamol, to evidence that safe time intervals had been observed. Guidance was not always in place for staff in relation to the application of topical creams and allergies were not always recorded on people's medicine administration record.

Whilst governance systems had improved since our last inspection, they had not been utilised effectively to identify issues we found in relation to the administration of people's prescribed medicines.

The provider and manager took immediate action during our inspection to address concerns identified in relation to medicine administration.

Risks to people's health, safety and well-being had been assessed and detailed plans were in place for staff to follow in order to keep people safe. People told us they felt safe with the staff who supported them and family members told us they were confident their relatives were well looked after.

Accidents, incidents and safeguarding concerns were recorded and acted upon appropriately. Systems were in place to ensure that learning was taken from incidents to prevent them occurring in the future.

There were enough staff available to ensure that people received their care within the agreed times. People and family members told us staff arrived on time and completed all the tasks they were required to complete. Safe recruitment processes were in place to ensure new applicants were safe to work for the service.

Staff had received training in infection, prevention and control and the provider had systems in place to ensure infection outbreaks were managed effectively.

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.

Improvements had been made since our last inspection. Positive feedback had been received from people, family members and staff about the manager and the overall service provided by ICare (GB) Limited-Knowsley.

Meetings were held with staff to provide them with important information about the service. The manager and provider had worked closely with the local authority to drive necessary improvements to people's 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 and update

The last rating for this service was requires improvement (published 8 July 2021) and there were 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 the provider remained in breach of some regulations.

Why we inspected

We carried out an announced focused inspection of this service on 25 and 30 March 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 safe care and treatment, staffing and governance.

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.

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 remained 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 ICare (GB) Limited-Knowsley on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines management and governance. Please see the action we have told the provider to take at the end of this report.

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

I Care (GB) - Limited Knowsley is a domiciliary care agency providing personal care to adults in their own homes. The service was supporting 119 people at the time of the inspection.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. ‘Personal Care’ 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

People’s level of risk and support needs were not adequately managed. People were not receiving the appropriately level of care, their safety was often compromised, and they were exposed to unnecessary and avoidable harm.

Infection prevention and control (IPC) arrangements and procedures were not effectively in place. The provider was not following best practice guidance in relation to the homecare testing service. The provider was not effectively managing or preventing the transmission of COVID-19, meaning vulnerable people were unnecessarily exposed to the virus.

Medication management procedures were not safely in place. We found inconsistent and inaccurate medication information in people care records, paper and electronic medication administration records (MARs) were not always appropriately completed and we were not always assured that people were safely supported with the medication they needed.

Accident and incident reporting procedures were in place. However, we identified a significant medication incident that had not been appropriately reported or investigated. We were not always assured that all significant events were appropriately managed.

We identified concerns in relation to staffing levels and the deployment of staff. There was evidence of missed calls, extremely early and late calls. Although people told us they were happy with the provision of care they received, they did not always receive the support that had been agreed. Recruitment of staff was appropriately managed; people received care and support by staff who had undergone the appropriate recruitment checks.

Quality assurance measures and processes were not effectively in place. There were no systematic or robust processes to monitor, review or assess the provision of care people received and no evidence to support how improvements were being made.

Policies and procedures did not always contain the most relevant or up to date information; there was evidence to suggest that although policy updates had recently taken place, they did not always contain the most relevant and pertinent information staff needed.

Overall governance and general oversight of the quality and safety of care required improvement. The provider as well as the registered manager are accountable for the provision of care people receive; we were not always assured that management roles and responsibilities were clearly understood as we identified a number of regulatory breaches throughout the inspection.

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 14 January 2019)

Why we inspected

The inspection was prompted (in part) due to concerns and risks that were identified at another ICare (GB) Limited location. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the ‘Safe’ key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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 and well-led key question of this full report.

Following the inspection, an action plan was submitted which helped to mitigate some of the areas of the risk we identified.

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 safe care and treatment, staffing and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 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. We will request that the provider submits further action plans to determine if they have addressed the breaches of regulation we identified.

We will meet with the provider following the publication of this report to discuss how they will continue to make changes to ensure they improve their rating to at least ‘Good’. We will work with the local authority to also monitor progress.

This comprehensive inspection took place on 12 and 18 December 2018 and was announced.

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.

The registered manager and care manager had systems for reviewing, monitoring and assessing the quality of the service. The provider was undertaking their own internal audits of the records; therefore, they were able to demonstrate how they monitored and identified any shortfalls. There was a plan to collate all information gathered and to take action to drive improvements.

The registered manager had ensured that staff received regular support, training and supervision and had the skills, knowledge and experience required to support people with their care and support needs. Training materials were up to date and reflected current good practice guidelines and legislation.

People received their medicines on time and the information available to staff about people's medicines was up to date. There were risk assessments in place so that staff had the guidance they needed to ensure people received their medicines safely. People's risk assessments were in place and had been updated and reviewed to reflect changes in their needs.

Care records were informative and up-to-date. Each person using the service had a personalised care and support plan and a risk assessment. All records we saw were complete, up to date and regularly reviewed. We found that people and their relatives were involved in decisions about their care and support.

We found that recruitment practices were in place which included the completion of pre-employment checks prior to a new member of staff working at the service and disciplinary procedures had been followed appropriately and in accordance with policies.

Staff received a comprehensive induction programme, regular training and supervision to enable them to work safely and effectively. There was also an up to date staff handbook that all staff were given and also staff were informed when there were any updates.

People's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary and when people requested their support.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place and training to guide staff in relation to safeguarding vulnerable adults.

The service had quality assurance processes in place including service user questionnaires. The service’s policies and procedures had been reviewed and updated in 2017 -2018 by the provider and these included policies on health and safety, confidentiality, mental capacity, medication, whistle blowing, safeguarding and recruitment.

People told us they were happy with the staff and felt that the staff understood their care and support needs. The five people we spoke with and four relatives had no complaints about the service. The provider had a complaints procedure in place and this was available in the ‘Service User Guide’ and in place at the homes of the three people we visited.