Background to this inspection
Updated
8 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by four inspectors. Two inspectors visited the office location, one inspector visited people in their homes and a fourth inspector conducted telephone interviews with people, their relatives and staff.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was also a director of High Care Plus Ltd. We have referred to them as the provider throughout the report.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or provider would be in the office to support the inspection.
Inspection activity started on 29 October 2019 and ended on 8 November 2019. We visited the office location on 29 October 2019.
What we did before the inspection
Prior to this inspection we reviewed all the information we held about the service, including data about safeguarding and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
We contacted the local authority to discuss information they had received in relation to concerns raised by people and their families
We used all of this information to plan our inspection.
During the inspection-
As part of our inspection we visited three people in their homes who received a service from High Care Plus to seek their views on care. In addition, we spoke with four people and two relatives on the phone to ask their opinion of the service they received. We also spoke with the provider and a second director of High Care Plus Ltd. We reviewed a range of documents about people's care and how the service was managed. We looked at seven care plans, seven staff files, medication administration records, risk assessments, policies and procedures and internal audits that had been completed.
After the inspection
Due to the concerns identified during our inspection we continued to request assurances from the provider regarding measures they had taken to ensure people’s safety. We liaised closely with the local authority to ensure people’s care was monitored.
In addition, we sought clarification from the provider to validate evidence found. We asked for updates regarding people’s care, risks to their safety and well-being, staff rostering information, recruitment and training checks. We spoke with four staff members employed by the service.
Updated
8 July 2021
About the service
High Care Plus Ltd is a domiciliary care service providing personal care to people in their own 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 the service supported 23 people with personal care needs.
People’s experience of using this service and what we found
There was a lack of managerial and provider oversight of the service which meant risks to people’s welfare and safety were not being robustly managed. Systems in place had not ensured people received their care calls. This had led to people’s care calls being missed or provided later than planned. The provider did not have robust systems in place to monitor staff practice, knowledge of people and understanding of their needs.
Risks to people’s safety were not always assessed and acted upon. Medicines processes were not safely managed and records did not evidence that people were receiving their medicines in line with their prescriptions. Robust recruitment processes were not in place and the provider had not monitored staff training and support. Staff had not completed training appropriate to people’s specific needs such as dementia, epilepsy and pressure care.
Systems were not in place to monitor and report concerns such as safeguarding, complaints and accidents and incidents. This meant the local authority were not aware of potential risks and appropriate action was not always taken to minimise the risk of concern happening again. The provider had failed to notify CQC of significant concerns in line with their statutory responsibilities.
People’s needs were not always fully assessed. Not all those receiving care had a care plan in place to guide staff on how their care should be provided. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
We received positive feedback from people regarding the staff who supported them. They told us they were caring and respected their privacy.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 26 November 2018 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about people’s care calls being missed and staff not taking action where there was no response on arrival at a person’s care call. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. The provider has taken action to minimise risks to people’s safety and are working with the local authority to monitor the service.
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 the safe recruitment, training and deployment of staff, the monitoring of risks to people safety, the failure to report safeguarding concerns and to record and monitor accidents and incidents, complaints and missed calls. Person-centred care was not embedded into practice, assessments were not robustly completed and care plans were not completed for all those receiving a service. There was a lack of management oversight of the service and quality assurance systems had not been implemented.
Full information about CQC’s regulatory response to these concerns can be found at the end of this report.
Follow up
We will request an action plan for 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.
The overall rating for this service is ‘Inadequate’ and the service 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.