Archived: Elizabeth Homecare Limited

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.

Elizabeth Homecare Limited provides care and support to people who live in their own homes in Goole and surrounding areas. This service is a domiciliary care agency. The service is registered to provide the regulated activity of personal care to children 13-18 years, people with dementia, people with learning disabilities or autistic spectrum disorder, people with mental health, older people, people with a physical impairment, people with a physical disability, people with sensory impairment and young adults. At the time of our inspection 89 people were receiving a service from this provider.

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

The provider failed to ensure that all staff employed at the service were tested for COVID-19 on a regular basis throughout the pandemic in line with government guidance. We found that no COVID-19 risk assessments had been completed for service users and staff. Masks were not worn by office staff when we visited the office.

The provider failed to ensure appropriate assessments and risk assessments were completed for service users who had risks associated with their care needs. Risk management plans were not in place for people who required support with moving and handling needs and specific health conditions including Diabetes and Epilepsy.

People’s medicines were not managed safely. There was no guidance for staff to follow on when to administer ‘as required’ medicines.

People and staff told us there were not enough staff to meet people’s needs. This meant that at times a family member had to support as the second carer. People told us they did not always feel safe with these arrangements which included using moving and handling equipment.

There was a lack of provider and managerial oversight of the service. There was a failure by the provider to ensure robust governance arrangements were in place to monitor the safety and quality of the service. Shortfalls across the service such as poor risk management, lack of oversight of accidents and incidents and limited oversight of safeguarding had not been identified prior to our inspection. These failings resulted in multiple breaches of regulation.

The provider had failed to notify the Care Quality Commission of certain events as required by law.

There was no policies or procedures in place for a number of aspects of the service provision. For example, to ensure the safe recruitment of staff.

Staff did not receive regular supervision or have an appraisal and there was no information available to show that checks of staff’s competency had taken place.

Staff had little understanding of the Mental Capacity Act 2005. There was no system within care records to evidence that assessments of people’s mental capacity had been completed. There were no records to show that where decisions had been made in people’s best interests this was done in line with the principles of the MCA 2005.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not 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/or autistic people.

This service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Care was not always person centred to promote independence. There was no evidence that consent had been sought in a way that meets a person’s communication needs and the knowledge of staff did not support providing care to people with a learning disability or autism.

People’s care plans were not person centred and lacked details about their preferences and goals they wanted to achieve.

We have made a recommendation about duty of candour.

People’s privacy and dignity was respected, and staff knew how to promote independence. People spoke positively about staff.

We found multiple breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC's regulatory response to the more serious concerns during inspection is added to reports after any representations and appeals have been concluded.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 22 December 2017)

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

We have found evidence that the provider needs to make improvements. Please see the key questions sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elizabeth Homecare on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to consent, safeguarding, management of medicines, staffing, infection prevention and control, record keeping, complaints, notification of other incidents 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

When we completed our previous inspection in September 2015 we found concerns relating to the way the service was managed and we made recommendations for improvement in the Well led section of the report. During this inspection we checked and found the provider had implemented improvements.

Elizabeth Homecare Limited provides care and support to people who live in their own homes in Goole and surrounding areas. This service is a domiciliary care agency. The service is registered to provide the regulated activity of personal care to people with dementia, learning disabilities or autistic spectrum disorder, mental health, older people and people with a physical disability. The provider also provides an intermediate care service that is designed to help people regain their independence. At the time of our inspection 91 people were receiving a service from this provider.

Not everyone using Elizabeth Homecare Limited receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’, which is help with tasks related to personal hygiene and eating. Where they do receive this type of support we also take into account any wider social care provided.

There was a registered manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

As part of the legal requirements of their registration, providers must notify us about certain changes, events and incidents that affect their service or the people who use it. During the inspection we found that notifications had not been submitted about an incident relating to the service that was reported to or investigated by the police. We have written to the provider regarding this.

Systems and processes were maintained to record, evaluate and action any outcomes where safeguarding concerns had been raised which helped to keep people safe from avoidable harm and abuse.

The provider ensured there were sufficient skilled and qualified care workers to meet people's individual needs and preferences. People confirmed they received care and support from regular care workers who they knew. Continuous monitoring helped to ensure that visits were not missed.

Risks for people and for staff from their environment were assessed and managed through individual risk assessments. These provided care workers with information to help keep both people and themselves safe from avoidable harm with minimal restrictions in place.

Procedures were in place to guide staff on the safe administration of medicines and staff had received medicines training. People confirmed, and the records we checked showed, that people had received their medicines as prescribed.

The provider had systems and process in place to ensure care workers were appropriately recruited into the service.

Care workers had received support through a regular system of supervisions and appraisals. Competency observations had also been completed to monitor staffs performance and ensure they were providing safe and effective care and support.

Care workers had access to a policy and procedure that provided with them guidance on working with people who might lack capacity under the MCA. Care workers had completed training on the Mental Capacity Act 2005 (MCA) as part of their induction training and were able to discuss the importance of supporting people with their independence.

People had received an assessment of their need to ensure they were suitable for the service. Care plans were centred on the individual and reviewed monthly. Updates were added in ‘real time’ and care workers confirmed that information was always up to date. We saw care plans included information to ensure care workers were informed and respectful of people’s cultural and spiritual needs.

People were supported to maintain a healthy and balanced diet. We found that care plans contained details of people’s preferences and any specific dietary needs they had, for example, whether they were diabetic or had any allergies.

The provider ensured they had close working relationships with other health professionals to maintain and promote people’s health.

Care workers had a good understanding of people's needs and were kind and caring. They understood the importance of respecting people's dignity and upholding their right to privacy.

There was information available on how to express concerns and complaints. People were encouraged to raise their concerns and these were responded to.

There were systems of audit in place to check, monitor and improve the quality of the service. Associated outcomes and actions were recorded and these were reviewed for their effectiveness.

The provider worked effectively with external agencies and health and social care professionals to provide consistent care.

Everybody spoke positively about the way the service was managed. Care workers understood their levels of responsibility and knew when to escalate any concerns.

Quality assurance checks including audits provided oversight at provider and director level. People and their carer workers were consulted and action plans formulated that aimed to improve the quality and delivery of the service.

The provider used the local authority's medication system to administer medicines to people who used the service. Staff had received training in its use and the provider carried out regular audits to ensure staff practice was safe and effective.

Robust employment and recruitment practices were in place. One relative who spoke with us said 'The agency must use good recruitment techniques because my parent has received care from a number of staff and they have all been excellent workers and are extremely pleasant towards my parent'.

The agency employed sufficient staff to ensure people were looked after by staff who understood their needs and who were competent in their roles. People whose care included use of equipment such as a hoist told us 'The staff know what they are doing. They are very competent when using the equipment. Some of the newer staff might need a few reminders but they usually pick things up quickly'.

People were aware of the complaints procedure and knew how to use this if needed. People said they had completed satisfaction questionnaires and were part of the care planning process.