Background to this inspection
Updated
8 October 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 team consisted of five inspectors, a medicines inspector and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
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 (CQC). 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.
Notice of inspection
This inspection was unannounced. We visited the location on 9, 10 and 13 August 2021.
What we did before the inspection
Before the inspection we looked at information we held about the service. This information included feedback we had received about the service and any statutory notifications that the provider had sent to the CQC. Statutory notifications include information about important events which the provider is required to send us by law. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.
During the inspection
We spoke with the registered manager. The nominated individual is responsible for supervising the management of the service on behalf of the provider. Following the visit to the office, we spoke with 21 staff including the medicines lead, a care coordinator and the manager, 27 people using the service, 13 relatives, and received written feedback from a social care professional.
We reviewed a range of records which related to people's individual care and the running of the service. These records included 16 care files, 12 staff records, policies, medicine administration records and a range of records relating to the management and quality monitoring of the service.
After the inspection
We continued to seek clarification from the registered manager to validate evidence found. The registered manager was responsive in providing us with information and documentation to do with the management and running of the service.
Updated
8 October 2021
About the service
Capital Homecare (UK) Limited is a domiciliary care agency registered to provide personal care to people in their own homes, including children and young people under 18. At the time of this inspection, 270 people were receiving assistance with their personal care. The Care Quality Commission (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
Whilst most people spoke positively of the level of care and support, they received from Capital Homecare (UK) Limited, we found weaknesses in governance arrangements. There was not a programme of effective regular audits to assess the quality of key areas of service to identify deficiencies and make improvements. A system of monitoring the service in this way will assist the provider to track progress and ensuring that care was consistent and reliable to all people. The absence of an efficient system disproportionately impacted people with higher needs.
We identified some strengths in the partnership approach, particularly in the initial stages of a care package. However, we identified strategic gaps in risk management in response to people’s changing needs. Care had not always continued to be provided in an integrated way. Improving communication with others providing care to people would ensure that care is joined up, more so in managing urgent issues. On that basis, we made a recommendation for the provider to update its framework of incidents management, covering how information was sufficiently shared with partners.
People received their medicines as prescribed, but an improvement was required in the way the provider managed PRN (as required) medicines. This was linked to the governance systems, which should have identified this. We made a recommendation to that effect.
This was also the case with staff development. We found staff were equipped with training and were receiving supervision and appraisals to do their jobs effectively, but there were gaps in the support framework. We made a recommendation for improvement.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Whilst most people were supported to receive a diet that met with their nutritional and cultural needs, some people were not supported to receive a diet that met their personal preferences.
Therefore, in the final analysis, we judged the provider was variably meeting the basic needs of people. We found staff to be caring and compassionate. They mostly visited people on time and in most examples, understood and met people’s choices. However, a few people with higher needs required an effective system of governance that would promptly identify and escalate their needs. The current system was not facilitating this.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
The inspection was prompted in part due to concerns received about leadership and general governance. A decision was made for us to inspect, focusing on all key questions, safe, effective, caring, responsive and well-led.
Enforcement
We found three breaches of regulations and you can see what action we told the provider to take at the back of the full version of the 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.