Background to this inspection
Updated
8 November 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
Two inspectors carried out this inspection. An Expert by Experience made telephone calls to people and their relatives. 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
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 it we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 28 September 2022 and ended on 10 October 2022. We visited the location’s office on 28 September 2022.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.
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.
During the inspection
We spoke with 9 family members and 6 people who used the service about their experience of the care provided. We spoke with 9 members of staff including the nominated individual, registered manager, the training coordinator and six care workers. We reviewed a range of care records and medicines records. We looked at 3 staff files in relation to recruitment and staff supervision and records relating to the management of the service.
The nominated individual is responsible for supervising the management of the service on behalf of the provider.
Updated
8 November 2022
About the service
Elizabeth Home Care is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection there were 86 people using the service. 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
New systems and processes had been implemented since the last inspection. However, further work was required to embed them and ensure they were fully effective. The systems in place had not always made improvements to the service. For example, we found medication errors and missed calls continued to be inconsistent. Some records were not always accurate, or robust.
At times calls were missed meaning people did not receive the care they required. There was no robust monitoring to prevent missed calls.
Staff had received safeguarding training and procedures had been implemented. People felt safe with the support they received from staff. Accidents and incidents were monitored by the management to ensure prompt referrals were made when required.
Significant improvement had been made to update staff training which was tailored to individual learning styles. Staff received supervisions and told us they felt supported in their roles.
People were happy with the care they received and told us staff delivered care how they wished. People had been involved in the development of their care plans. The provider had made improvements to the care plans, but further work was required to ensure these were always accurate.
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 support this practice.
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 March 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, although some improvements had been made, we found the provider remained in breach of some regulations.
At our last inspection we recommended that the provider implemented procedures for recruitment and duty of candour. At this inspection we found the provider had met the recommendations.
This service has been in Special Measures since 22 February 2022. 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 announced comprehensive inspection of this service on 25 and 29 November 2021. Multiple breaches of legal requirements were found.
We undertook this focused inspection to check whether the Warning Notice’s we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. And the requirement notices for regulation 11, 13 and 18 had been met. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive 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 Elizabeth Home Care on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to medicines, staffing and 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.