Continuity Healthcare Services Private Limited

Continuity Healthcare Services Private Limited is a domiciliary care agency providing personal care to adults in their own homes. This includes people with dementia, learning disabilities or autistic spectrum disorder, mental health needs, sensory impairments and physical disabilities. 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 inspection 183 people used the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and autistic people. We were not assured people were supported to make decisions about their care and welfare in their best interests.

Since our previous inspection, processes, procedures and checks on the quality of service people received had been improved. However, governance systems were not established and did not always identify areas where improvements were required. New governance systems and quality assurance procedures needed to be embedded into practice, to ensure their effectiveness.

Staff training had improved, and staff received training in areas such as how to recognise the signs of abuse, and how to administer medicines safely. The provider had plans to continue to improve training.

Overall, people and staff confirmed there were enough staff to attend scheduled care calls. However, people told us sometimes staff arrived late, and communication when care staff were running late could be improved.

People’s medicines were administered by trained staff. There was paperwork in place to record when people received their medicines. However, processes needed to be improved to record when people should receive medicines on an ‘as required’ basis, and how patch medicines should be administered.

It was not clear if people were supported to have maximum choice and control of their lives and if staff supported them in the least restrictive way possible and in their best interests. Policies and procedures were in place to test people’s capacity, however, there was a lack of understanding about when best interests’ decisions were required for people’s care, and how decisions should be recorded.

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 July 2022) and there were breaches of regulations. This service has been in Special Measures since July 2022. During this inspection the provider demonstrated that improvements had 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.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. At this inspection we found the provider remained in breach of regulation 17 good governance.

Why we inspected

We carried out an announced comprehensive inspection of this service in May 2022. Some breaches of legal requirements were found. The provider was in breach of regulation 12 safe care and treatment, regulation 13 safeguarding, regulation 19 fit and proper persons, and regulation 17 good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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 Continuity Healthcare on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to regulation 17 good governance at this inspection.

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.

Continuity Healthcare Services Private Limited is a domiciliary care agency providing personal care to adults in their own homes. This includes people with dementia, learning disabilities or autistic spectrum disorder, mental health needs, sensory impairments and physical disabilities. 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 inspection, the provider was unable to confirm the number of people it was providing personal care to and stated figures between 319 to 340 people.

People’s experience of using this service and what we found

There had been significant changes in the staffing structure of the service since August 2021. The provider failed to have sufficient oversight of the changes, which meant governance systems were not established and events which called into question people’s safety were not always identified and managed to protect people. The provider was not aware of many of their legal responsibilities as the registered person.

There were significant gaps in training for all staff and senior staff told us they had not received essential training required for their role when they started work.

The provider was unable to demonstrate whether there were sufficient numbers of staff to meet each person’s scheduled care calls.

People’s medicines were not always administered as prescribed. There were no processes in place to manage how people received their time critical medicines. There was no system in place to ensure staff always recorded when people received their medicines.

It was not clear if people were supported to have maximum choice and control of their lives and if staff supported them in the least restrictive way possible and in their best interests, because there were no policies or systems in place to support this practice. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and autistic people. We were not assured people were supported to make decisions about their care and welfare in their best interests.

People had conflicting views about whether staff supported them in a caring way. People were involved in their assessments and decisions regarding care planning. One person told us, “I was involved and a person from the office visited to check what was needed.” However, people’s care plans did not always include risk mitigation plans for people with specific health conditions, or guidance for staff about how to care for people safely.

People felt able to raise any concerns with staff. However, complaints had not been managed in accordance with the provider’s policy.

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 22 April 2021 and this was the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about missed care calls and increased safeguarding concerns. 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 all the sections of this full report for details.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care, safeguarding, good governance and employing fit and proper person’s, 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 wrote to the provider and requested some information to be sent to us urgently and asked what they were going to do to mitigate the risks identified and to keep people safe. The provider responded demonstrating some immediate actions taken.

Special Measures

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.