Background to this inspection
Updated
11 October 2022
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 Health and Social Care Act 2008.
Inspection team
This inspection was carried out by two inspectors, an inspection manager and an expert 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.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. At the time of our inspection there was not a registered manager in post.
Notice of inspection
We gave a short period notice of the inspection. This is because the service it is a small service and we needed to be sure that the provider would be in the office to support the inspection.
Inspection activity started on 18 August 2022 and ended on 26 August 2022. We visited the location’s office 18 and 23 August 2022.
What we did before the inspection
We reviewed information we had received about the service and sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
We spoke with the provider, director of care, a care manager and five members of staff. We also spoke with four people who used the service and five relatives either by telephone or in their homes. We reviewed a range of records. This included five people’s care records, medication records and a variety of records relating to the management of the service including policies and procedures. We also reviewed five staff files in relation to recruitment along with records relating to staff supervision and training.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We contacted two professionals who worked with the service and sought additional information from the local authority and commissioners. We continued to receive whistle-blowing concerns about the service and the provider informed us of their intention to stop all regulated activities.
Updated
11 October 2022
About the service
We (Always) Care Under One Roof Limited is a domiciliary care service providing personal care to people aged 65 and over. At the start of the inspection there were seven people receiving a service. However, during the inspection this changed to one person receiving a 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
The provider had not ensured systems to assess and monitor the quality of the service, such as audits and oversight, were sufficiently robust and effective. Safe recruitment procedures had not been followed and the provider had not ensured sufficient numbers of staff were available or that staff had received appropriate induction, training and support relevant to their role. The provider did not always demonstrate a clear understanding of their regulatory responsibilities.
Families were frequently relied upon to assist care staff during calls which required two staff due to there being insufficient staff to cover. People’s individual needs and risks had not been robustly assessed and incorporated into person-centred care plans. The provider was not following guidance relating to the requirement of staff testing for COVID-19.
Travel time between calls was not always sufficient which resulted in people’s calls sometimes being late or cut short. When staff supported some people with their meals a choice of available foods was offered.
People were supported to have maximum choice and control of their lives although staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff were aware of signs of abuse and steps to take should abuse occur. People spoke highly of the staff and told us their dignity was respected at all times. People had not always seen a copy of their care plan and told us they were not able to access the electronic system used by staff. Records did not always evidence that people had been involved in how their care was to be delivered, although the provider told us a review to address this was underway.
People felt able to raise concerns and there was a policy and procedure in place to handle and respond to complaints, although we found one person had not received a response to their complaint.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The service was registered with us on 25 July 2018 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels, recruitment, training, induction and overall management of the service. 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.
Enforcement
We have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed and 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
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.