Background to this inspection
Updated
22 July 2023
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 2 inspectors.
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 not a registered manager in post.
Notice of inspection
We gave the service short notice of the inspection. This was because 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 21 February 2023 and ended on 2 March 2023. We visited the location’s office on 1 March 2023.
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 and professionals who work with the service. 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 information gathered as part of monitoring activity that took place on 17 March 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.
During the inspection
We spoke with 2 relatives about their experience of the care provided. We also spoke with 4 members of staff including; the nominated individual, the manager and 2 support workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included 2 people's care records and 2 staff files in relation to recruitment and staff supervision.
Updated
22 July 2023
About the service
Voice2Care Ltd is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection the service was providing personal care to 2 people, this included older people and people living with physical disabilities.
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
Risks to people’s safety were not adequately assessed, monitored or managed. This included risks associated with people’s skin integrity, their home environment, and their mobility. Medicines were not always managed safely, and the service was not clear about its role in relation to the administration of medicines. Safe recruitment practices were not always followed when employing new staff, which meant the provider could not ensure people employed were of good character and safe to work with vulnerable people. Systems and processes had not been fully established, to learn lessons when things go wrong.
Staff were not adequately trained and did not always receive ongoing support through supervisions and appraisals. People’s needs were assessed prior to their care and support commencing, but the assessment process was not effective. Care records contained no evidence people, and their relatives were involved in decisions about their care.
The provider had failed to ensure people were involved in the assessment of their needs, or that care was person-centred and reflected people’s preferences. Care plans did not always identify or record people’s communication needs. End of life care for people did not always reflect their individual preferences.
We have made a recommendation about involving people in decisions about their care and meeting people’s communication needs.
Leaders did not have the necessary skills or experience to deliver a safe service. The provider had failed to establish effective quality assurance processes or a system of quality performance checks to support staff. This meant opportunities to drive improvements in the service were missed. The provider had also failed to establish effective systems for gathering views from people, their relatives and staff.
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; but the policies and systems in the service did not always support this practice. The service had not ensured it obtained people’s consent to their care.
Relatives told us they felt the service was safe. There were enough staff employed to meet people’s needs and provide continuity of care. There were systems in place to prevent and control the spread of infection. Relatives told us staff were kind and caring, and respected people’s privacy and dignity and promoted their independence when possible. Staff we spoke with told us they enjoyed their jobs and relatives spoke positively of the approachability of staff.
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 31 August 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 and Recommendations
We have identified breaches in relation to person-centred care, safe care and treatment, good governance, staffing and recruitment.
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 will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
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.