Rapid Care

Rapid Care is a domiciliary care agency providing personal care to people in their own homes.

Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of the inspection 70 older people were receiving this support.

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

Risks to people’s health, safety and welfare had not been consistently assessed and there was a lack of guidance for staff about how to support people safely. Whilst staff understood how to support people, and had completed regular training, there was a risk new staff may not support people safely.

People were not supported by staff who had been safely recruited. Checks with previous employers had not been consistently completed. Obtaining references from previous employers helps to make sure new staff are safe to work with people.

There was a lack of oversight at Rapid Care. Whilst some checks and audits were being completed, they were not routinely recorded. Shortfalls identified throughout the inspection had not been recognised by the management team.

Accidents and incidents had been recorded and action taken to ensure people were safe. These had been raised with the local authority safeguarding team, however notifications for 2 incidents had not been reported to CQC in line with guidance.

People were supported by staff who understood the potential signs of abuse. Staff felt confident to raise concerns and told us action would be taken to keep people safe.

People told us their care calls were generally on time and they received support from regular carers. People received their medicines on time and as prescribed.

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.

People and their relative spoke positively about the care and support they received. They felt listened to and had provided positive feedback in quality assurance surveys. Staff felt valued and supported by the management team.

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 9 May 2018).

Why we inspected

We received concerns in relation to the recruitment of staff. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led 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 Rapid Care on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk assessing, recruitment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

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.

At the last Care Quality Commission (CQC) inspection on 14 March and 5 April 2017, the service had an overall rating of Good.

This service is a domiciliary care agency based at an office in Rainham. It provides personal care to people living in their own homes. This included older people, younger adults and people with complex health needs such as epilepsy, diabetes and physical disabilities. There were 84 people receiving personal care from the service at the time of our inspection.

A registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission 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.

At this inspection we found the registered manager and provider had continued to monitor the quality of their service to maintain a rating of Good.

People told us that the service they received met their needs and was of good quality.

Rapid Care offered an inclusive service. The staff followed policies about Equality, Diversity and Human Rights.

The expected quality outcomes promoted in the provider's policies and procedures were monitored by the registered manager and the provider. There continued to be audits undertaken based on cause and effect learning analysis, to improve quality. Staff understood their roles in meeting the expected quality levels and staff were empowered to challenge poor practice.

The registered manager was consistent in asking about people’s experiences and continued to work at putting people at the heart of the service. People, their relatives and health care professionals had the opportunity to share their views about the service either face-to-face or by telephone.

People’s needs continued to be assessed and were kept reviewed. Staff understood the risks to people’s individual health and wellbeing and risks were clearly recorded in people’s care plans. Changes in risks and actions to minimise these were recorded.

There continued to be enough staff deployed to meet people’s physical and social needs. During the recruitment process for new staff the registered manager sought references, confirmation of identity, employment histories and checked staff’s suitability to deliver personal care to people who may need safeguarding by carrying out a criminal records check.

The registered manager continued to train staff so that they understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns they may have. Staff continually received training that matched people’s needs effectively and staff were supported with supervision and with maintaining their skills.

Emergency backup systems continued to be operated to allow care to continue at all times.

People’s medicines continued to be managed and administered safely.

The registered manager consistently understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA).

Staff supported people to maintain a balanced diet and monitor their nutritional health.

Management systems were in use to minimise the risks from the spread of infection, staff received training about controlling infection and carried personal protective equipment like disposable gloves and aprons.

We also found that risks relating to the delivery of care were not always properly assessed to enable risk to be minimised. We issued a warning notice to the provider requiring them to take action to assess and minimise risk within four weeks of the inspection.

We returned to carry out a focused inspection of three domains, Safe, Responsive and Well-led on 14 March and 5 April to check the provider had taken action to meet the regulations. At this inspection we found that the provider had implemented new ways of working to address the breaches from the previous inspection which has resulted in an improvement in the ratings for this service.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rapid Care on our website at www.cqc.org.uk

Rapid Care is a Domiciliary Care Service based in an office in Rainham, Kent. Staff are deployed from the office to provide personal care for people in their own homes. The care provided was tailored to people’s needs so that people could maintain or regain their independence. There were 68 people using the service at the time of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission 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.

People spoke about the staff in a positive light regarding their feelings of being safe and well cared for. They thought that staff were caring and compassionate. Care staff and managers were trusted and well thought of by the people they cared for.

The registered manager was supported to manage the service by the provider, a deputy manager and two staff supervisors. A care assessor was based at the office and assisted the registered manager to assess people’s suitability for the care provided.

Since our inspection in December 2016 the registered manager and the provider had reviewed the risk assessment formats and processes so that they could assess and manage risk to people’s safety during care.

A new medicines administration recording system had been introduced, that included more robust auditing and management oversight processes to ensure accurate records were maintained.

Managers planned people’s care to maintain their safety, health and wellbeing. Risks were assessed by staff to protect people. There were systems in place to monitor incidents and accidents. Quality audit processes had been updated to enable provider oversight.

The complaints system had been reviewed. There were policies in place, which ensured people would be listened to and treated fairly if they complained. The registered manager ensured that people’s care met their most up to date needs and any issues raised were dealt with to people’s satisfaction.

Staff had received training about protecting people from abuse. Procedures for reporting any concerns were in place. The registered manager knew how and when they should escalate concerns following the local authorities safeguarding protocols.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.

Staff were recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding. Recruitment policies were in place that had been followed. Safe recruitment practices included background and criminal records checks prior to staff starting work.

People were happy with the leadership and approachability of the service’s registered manager and management team. They had a clear quality based vision of the service they wanted to provide and understood how to achieve this. Management staff felt well supported by the provider. Audits were effective and risks were monitored by registered manager to keep people safe.

Rapid Care is a Domiciliary Care Service that provides personal care for people in their own homes. At the time of the inspection we were informed that 65 people were using the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission 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.

Risk assessments did not always identify the risks to people or others or the actions needed to mitigate the risks.

People's needs were assessed, however the care plans did not always reflect the actual care that was being provided by staff.

People received care from a consistent staff team. However identified risks to staff associated with lone working were not always managed appropriately.

Where the service was responsible for the administration of medicines, staff had not consistently followed safe practice in recording the medicines administration.

Complaints were responded to, but not always in writing in line with the providers own complaints policy.

The registered manager was knowledgeable of the needs of all people using the service and supportive of staff. However the internal audit systems were inconsistent and lacked management oversight in driving continuous improvement of the service.

Staff knew how to recognise signs of abuse and of what they needed to do to protect people from abuse.

The staff recruitment processes ensured that staff employed to work at the service had the right mix of skills, knowledge and experience and were suitable to work with people using the service.

Staff received appropriate training and support to enable them to carry out the duties they were employed to perform.

Staff were aware of the principles of the Mental Capacity Act (MCA) 2005 and they ensured that consent was obtained before providing people with their care.

Where the service was responsible, people were supported to have a balanced diet that promoted healthy eating. Staff took appropriate action in response to people’s changing health conditions requiring medical intervention.

People using the service and/or their relatives were involved in the care reviews. People were treated with kindness and compassion and their privacy was respected. The staff understood and promoted the principles of person centred care.

Staff aimed to deliver a quality service and understood and promoted the ethos and vision of the service.

You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.