Homesaints Limited

Updated 15 September 2022

The inspection

We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.

Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.

Inspection team

The inspection was carried out by one inspector 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 and flats.

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 a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the service is small, and people are often out, and we wanted to be sure there would be people in the office to speak with us.

Inspection activity started on 4 August 2022 and ended on 23 August 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, Healthwatch England and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

This performance review and assessment was carried out without a visit to the location’s office. We used technology such as video and telephone calls, written and verbal feedback to enable us to engage with people using the service and staff. We used electronic file sharing to enable us to review documentation.

Our inspection activity began on 4 August 2022 when the Expert by Experience spoke with five people and 10 relatives about their experience of the care provided. We spoke with the registered manager on 4 August 2022 to agree all documentation that we required to be submitted to CQC for review.

Between 11 August 2022 and 19 August 2022, we reviewed four people’s care records, two staff files and a variety of other assurance records and policies. We spoke with 10 members of staff including the registered manager and care staff. We communicated with two professionals. We continued to clarify information with the registered manager. We gave feedback to the registered manager about the inspection on 23 August 2022.

Updated 15 September 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not support anyone with a learning disability or an autistic person. The registered manager told us they intended to remove this specialism from their registration as they did not intend to support people with a learning disability or autistic people at this time. However, we assessed the care provision under CQC’s Right Support, Right Care, Right Culture (RSRCRC) policy, as it is currently registered as a specialist service for this population group.

About the service

Homesaints Limited is a domiciliary care agency providing personal care to people living in their own homes. People had various support needs and health conditions such as, dementia, multiple sclerosis and diabetes. At the time of our inspection there were 22 people using the service in receipt of personal care.

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

Right Support:

People were supported by staff who were caring but people did not always have their choice for their preferred gender of staff respected. Systems did not always ensure that all aspects of risks to people had been assessed and measures put in place to reduce them.

The rota was not planned in ways that meant care visit times were carried out at times people expected them. This resulted in people believing staff to be late, which impacted on their wellbeing.

People were supported with their medicines where required. Staff also understood how to support people in ways that promoted their independence.

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.

Right Care:

People were supported by staff who understood them and what they liked and most care was personalised. However, there was some aspects of care that was not person centred and resulted in concerns about care visits, meals and risks.

Staff ensured information was in formats they could understand, such as verbally or in writing.

People told us staff were kind and caring and treated them with respect. Staff understood how to promote people’s dignity and privacy.

Right Culture:

People were supported by staff who had not received all of the appropriate checks on their suitability for the role. Staff had a good understanding of how to promote people’s rights to make choices as well as how to recognise or report abuse and safeguard people they were supporting.

The registered manager promoted person centred approaches but these were not always delivered as required. Checks on staff knowledge and skills were made to ensure they could meet people’s needs. The registered manager completed various audits of care and records, but these were not always effective at identifying concerns.

People were not always supported to identify clear goals to promote their independence and ensure care was personalised.

The provider did not ensure complaints and outcomes were recorded.

We have made a recommendation about ensuring people’s meals and drinks were clearly recorded and the provider review recruitment records and practices.

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 12 May 2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 breaches in relation to risk management, personalised care, records and quality assurance systems 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.