Immaculate Healthcare Services Limited

Updated 4 May 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

The inspection was carried out by 1 inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

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 notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection. Inspection activity started on 6 March 2023 and ended on 9 March 2023. We visited the office location on 6 March 2023.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We used information gathered as part of monitoring activity that took place on the 9 January 2023 to help plan the inspection and inform our judgements.

We also 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 also reviewed notifications that the registered provider had sent to us since the last inspection. A notification is information about important events which the service is required to send us by law. We contacted 13 people or their relatives to seek their views of the service as part of monitoring activity in January 2023. We used all this information to plan our inspection.

During our inspection

We spoke with the registered manager and the registered provider. We reviewed a range of records. This included 10 people’s care records, 3 staff files, training records, staff supervision records and medicine administration records. We also looked at a variety of records relating to the management of the service, including policies and procedures.

Following the inspection, we spoke with a further 5 people or their relatives to obtain their views of the service. We also contacted 5 members of staff to ask them questions about their roles and to confirm information we had received about the service during our inspection.

Updated 4 May 2023

About the service

Immaculate Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own homes. 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. The service was supporting 60 people at the time of inspection.

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

Staff understood what abuse was and the actions to take if a person using the service was being abused. Risks associated with people’s care and support had been assessed and there was guidance in place to keep them safe. The provider had effective recruitment procedures to make safe recruitment decisions when employing new staff. There were enough staff to meet people’s needs. Systems were in place for the monitoring and prevention of infection. Staff assisted people to have their medicines as prescribed.

The provider had an on-going quality monitoring process to identify areas of improvement required within the service. The provider operated an open and inclusive culture where people, relatives, staff and other professionals were encouraged to help improve the service provided to people. Staff had access to a range of policies and procedures and this helped them to carry out their role. The management team and staff promoted the equality and diversity of people who used the service. The registered manager worked in partnership with other organisations to support and care for people. There was a range of monitoring and audit tools to assess and monitor the delivery of care and support to people.

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

Rating at last inspection

At the last inspection the service was rated Good (report published 15 September 2018).

Why we inspected

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.