Care Is Where The Heart Is Ltd

CARE IS WHERE THE HEART IS LTD is a domiciliary care agency providing personal care to people in their own homes. The service was supporting six people with personal care at the time of our inspection.

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

Care plans and risk assessments were in place for people. However, some risk assessments lacked sufficient detail to guide staff. The provider had failed to ensure accurate and up to date information regarding people’s medicines was in place. Staff were recruited safely. Systems were in place for staff to report and record incidents involving people. People were safeguarded from abuse.

People’s physical, mental health and social needs had not always been holistically assessed. Risk assessments and care plans contained contradictory information. The provider had not always liaised with other agencies to ensure people’s care needs were monitored and met. Staff received regular supervision.

The provider had failed to consistently analyse reports of incidents and accidents. The service did not always work in partnership with others. Staff felt supported by the provider and manager. People and their relatives were involved in 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. The provider was working within the principles of The Mental Capacity Act 2005.

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 Inadequate (published 21 April 2022) and there were breaches of regulation. 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 regulations. For the last four inspections the service has been rated requires improvement or inadequate.

This service has been in Special Measures since 16 March 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced comprehensive inspection of this service on 28 February 2022. Breaches of legal requirements were found in relation to person centred care, safe care and treatment, governance, staffing 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, 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 inadequate to 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 CARE IS WHERE THE HREAT IS LTD on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed. We have identified a breach in relation to good governance at this inspection.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Care Is Where the Heart Is LTD, is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 17 people with personal care at the time of our inspection.

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

The provider’s recruitment practices were not safe or robust, which meant people were at risk of being supported by unsuitable staff. Risk assessments had not always been completed in relation to known risks to people or plans developed for managing these risks. People’s medicines were not always managed and administered safely. The provider was not following current government guidance regarding COVID-19 testing. The provider had not consistently recorded, analysed or acted on incident and accidents

People’s needs and choices had not always been appropriately assessed to ensure effective outcomes of their care. People were not always supported by staff who had the skills and knowledge to meet their needs. People’s individual dietary needs were not always addressed. People did not always have timely access to healthcare services and support. The provider was not working in line with the principles of the Mental Capacity Act 2005.

We were not assured the provider or manager adequately understood regulatory requirements. The provider did not have effective quality assurance systems and processes in place. We were not assured the provider or manager understood their responsibilities under the duty of candour. Relatives gave us mixed views on the provider’s communication regarding people’s care. Staff working for the provider told us they felt supported.

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 10th December 2021) and there was a breach of regulation 17. 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 regulations. The rating for the service has deteriorated from requires improvement to inadequate. For the last three inspection the service has been rated requires improvement or inadequate.

Why we inspected

The inspection was prompted in part, due to concerns received about the safe care and treatment and governance of the service. We received concerns about the provider’s ability to support people safely and effectively. These concerns included infection control practices, poor recruitment practices, lack of staff induction and training, and poor medicines management. Conversations with the provider prior to our inspection, did not give us assurances in relation to these concerns. A decision was made for us to inspect and examine these risks.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to the provision of person-centred care, safe care and treatment, governance of the service, staffing training and supervision, and unsafe recruitment practices.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

CARE IS WHERE THE HEART IS LTD, is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 10 people from the location, with personal care at the time of our inspection.

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

People’s relatives told us their family members valued the care provided and were confident if they made suggestions for improving the service provided these would be listened to. However, the processes the provider had in place to check people’s care had not identified areas for improvement we found at this inspection. Further development of checks and audits were required in order to ensure opportunities to improve the service provided to people were consistently driven through. This included in identifying any patterns or trends relating to accidents, incidents and safeguarding, so learning could be taken from these. In addition, there were some inconsistencies in risk assessments and care planning and staff recruitment practices. The provider gave us assurances these would be addressed.

Improvements had been made in the way people’s risks were managed and the level of detail provided to staff to support people’s care needs. This included details of people’s individual health needs. We found some checks were working effectively, so the provider could be sure people received their medicines as prescribed, at the time people required these. In addition, the provider’s checks to make sure staff had the skills they needed when assisting people to move around their homes safely had improved. The provider and senior staff also undertook spot checks on how staff cared for people. This helped to give the provider assurance risks to people were reduced. Where any actions had been identified, these were addressed. The provider had further developed their spot check processes, which in the future will provide opportunities for people and relatives to give their experiences of the care provided.

There had been further changes to the staff managing the service and providing care. People’s relatives told us this had not affected their family member’s safety. Staff were positive about working for CARE IS WHERE THE HEART IS LTD and said the provider and senior staff took prompt action to support people if there were any concerns for their well-being.

Staff gave us examples of support provided to people, so people could maintain their relationships with family members. Staff also gave us examples showing how they worked with external organisations and professionals, such as GPs, occupational therapists and housing providers, so people had improved outcomes.

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 inadequate (published 30 June 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the service has improved to requires improvement. We found although some improvements had been made the provider continued to be in breach of a regulation. Please see the well-led section of this full report.

This service has been in Special Measures since 23 June 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The inspection was prompted in part due to concerns about people’s safety. For example, staffing arrangements, and the governance of the service, as the provider had not effectively demonstrated what they had done to improve since our last inspection. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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.

We found no evidence during this inspection that people had experienced harm from safety concerns. However, we have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

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 inadequate to requires improvement. This is based on the findings at this inspection.

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 CARE IS WHERE THE HEART IS LT D on our website at www.cqc.org.uk.

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 a continuing breach in relation to how the service is managed at this inspection.

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

Care is Where the Heart Is Ltd, is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 13 people from the location, with personal care at the time of our inspection.

The provider had moved office when we last inspected however, they had not notified us in advance of this change. They began the process of registering the new location after the last inspection, but they had not completed the registration process correctly. This location still remains un-registered as the provider has not submitted a new application to register the location.

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

There continued to be a lack of provider oversight which meant risks to people’s safety had not been identified and responded to appropriately. Systems to monitor the quality and safety of the service were not effective and placed people at the risk of harm. Systems in place had failed to identify the areas for improvement found at this inspection including care planning, risk management and safe administration of medication.

Care plans were not in place for known health conditions to provide staff with the information they needed to mitigate risk and meet or respond to people’s needs.

People and relatives, we spoke to said they felt safe and care staff knew them and their needs.

Medication administration records (MAR) were held on the electronic care planner. However, this did not include all medications prescribed for people using the service. This meant care staff did not have accurate records to refer to, ensuring they were giving the correct medication at the correct time.

Audits had been implemented however, they were not yet established enough to see if they will provide clear and robust information and evidence of outcomes for people.

Systems and process which were in place were not robust to protect people from potential harm.

Staff we spoke to told us they understood their roles and responsibilities, had received some training and felt supported by the management.

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 inadequate (published 21 April 2021) and there were multiple breaches of regulation. 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 some improvements had been made, however, the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part, due to concerns received about the safe care and treatment and governance. We received concerns about the providers ability to support people effectively, concerns included; infection control practices, staffing including poor recruitment practices, lack of induction and training, poor medicines management and concern about the ability to support people who had care packages in place. Conversations with the provider prior to our inspection, did not give us assurances in relation to these concerns. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service.

The overall rating for the service following this inspection remains inadequate. 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 sections of this full report to see what actions we have asked the provider to take.

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 identified breaches in relation to Regulation 17 Good governance due to the lack of provider oversight, systems and process’ in place to assess, monitor and improve the quality and safety of the services provided. Regulation 12 Safe care because people were exposed to the risk of harm as their care needs and risk associated with their care were not identified and recorded. Regulation 19 Fit and proper persons employed due to not following safe recruitment practices.

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

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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.

Care is Where the Heart Is, is a is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 18 people from the location, with personal care in their own homes at the time of our inspection.

The provider had recently moved office however, they had not notified us in advance of this change, they began the process of registering the new location after the inspection.

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

Some records were not available when requested at the time of the inspection at the office. This was due to documents such as care plans and risk assessments not being in place for people using the service.

There was a lack of provider oversight which meant risks to people’s safety had not been identified and responded to appropriately. Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm. The lack of systems in place had failed to identify the areas for improvement found at this inspection including the care planning, risk assessments, safe recruitment processes, nutrition and safe administration of medication.

Care plans were not in place for known health conditions to enable staff to have the information they needed to mitigate risk and meet or respond to their needs.

People and relatives we spoke to said they felt safe. However, one relative told us, their relative did not have a care plan and said, “I do worry that without a care plan they don't know how to care for [Name] correctly. They are having to ask her [mom] everything and they need to learn about her and her needs”.

Staff we spoke to told us they had received some training to meet people’s needs.

Medication administration records (MAR) were held on the electronic care planner system and did not always include the current list of medications prescribed for people using the service. This meant care staff did not have accurate records to refer to, ensuring they were giving the correct medication at the correct time.

Audits need to be implemented to provide clear and robust information and evidence of outcomes for people.

Systems and process which were in place were not robust to protect people from potential harm.

Staff we spoke to told us they understood their roles and responsibilities, had received some training and felt supported by the management.

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)

This service was registered with us on 08/12/2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the safe care and treatment due to infection control practices, staffing levels and the ability to support people who had care packages in place with Care is Where the Heart Is. Conversations with the nominated individual prior to inspection, did not give us assurances in relation to these concerns. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service.

The overall rating for the service following the first inspection is Inadequate. 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, caring, responsive and well-led sections of this full report to see what actions we have asked the provider to take.

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 Regulation 17 Good governance due to the lack of provider oversight, systems and process’ in place to assess, monitor and improve the quality and safety of the services provided. Regulation 12 Safe care because people were exposed to the risk of harm as their care needs and risk associated with their care were not identified and recorded. and treatment and Regulation 19 Fit and proper persons employed due to failing to follow safe recruitment processes at this inspection.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.