Background to this inspection
Updated
16 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.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 2 inspectors and 2 Experts by Experience. 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 is a domiciliary care agency. It provides personal care to people living in their own homes.
The regulated activity of nursing care is in the process of being removed by the provider and no nursing care was being provided at the time of the inspection.
Notice of inspection
This inspection was announced. We gave short notice on 15 March 2023 to the registered manager. This was so they would be available to support the inspection process.
Inspection activity started on 15 March 2023 and ended on 25 April 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, the local Clinical Commissioning Group (CCG) and Healthwatch. The local authority and CCG purchase packages of care when people do not purchase their own care and support. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
We used 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 used all the information service to plan our inspection.
During the inspection
This inspection was carried out using technology such as video calls and telephone calls to enable us to engage with people using the service and staff. We used electronic file sharing to enable us to review documentation. We undertook a site visit to the provider’s office.
We spoke with 19 people and 21 relatives to gain their feedback on the service. Additionally, we spoke with 4 care staff, 2 care supervisors, the domiciliary care administrator, the supported living manager, the registered manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. Further email feedback was received from 11 care staff.
We reviewed a range of records. This included 4 people’s full care plans and 8 people’s records related to risk management. Assessments, reviews of care and medicine administration records were looked at. We looked at a variety of documents relating to the management of the service, including quality monitoring checks. We reviewed 3 staff recruitment files.
Updated
16 May 2023
About the service
The Care Bureau Limited Leamington Spa is a domiciliary care agency which is registered to provide nursing care and personal care and support to people in their own homes. The service is registered to provide support to younger adults and older adults, people living with dementia, mental health needs and sensory impairments, physical disabiltiy and people with a learning disability and autistic people.
At the time of our inspection the service was supporting 106 people; younger and older adults who were receiving 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.
At the time of the inspection, the service did not provide a regulated activity of nursing care to anyone. The provider was in the process of having the regulated activity of nursing care removed from their service provision. We have therefore not reported on the regulated activity of nursing care in our report.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
At the time of the performance review and assessment, the service did not provide a regulated activity to anyone with a learning disability or autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a service for this population group.
Right Support: 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; overall the policies and systems in the service supported this practice. Where people lacked mental capacity improvement was needed to include important information about who could make decisions on their behalf in their plan of care.
Staff had been trained and completed agreed support tasks on care calls.
Staff were recruited in line with the provider’s policy, but improvement was needed in the provider’s check on information received, such as references, to ensure these always covered staff’s employment histories.
Right Care: People’s care, treatment and support plans did not always reflect give staff the information they needed to provide safe care. Risk management plans did not provide detail on the safe actions staff should take to ensure risks of harm or injury were minimised.
Staff ensured people’s rights and dignity were promoted and protected. Infection, prevention and control was managed well.
People said they felt safe with staff in their homes. Staff understood how to protect people from the risks of abuse and how to report any concerns.
Right Culture: The nominated individual and the registered manager did not consistently have good oversight of the service. Quality checks took place, but these did not always identify where improvements were where needed. The provider’s own checks had not identified the shortfalls we found in risk management, the safe handling of medicines and medicine administration records, care plan records and one staff recruitment check.
The nominated individual and the registered manager had not always ensured we (CQC) were always informed about incidents we should be legally told about.
The nominated individual and the registered manager were open to inspection feedback from us and were willing to learn lessons and make improvements where needed.
Feedback was sought from people, relatives and staff about how they felt about the service they received. This was positive about the hands-on caring approach by staff.
Staff were valued and said they felt supported by the management team. Staff felt proud to work for the company.
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 15 September 2018).
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 safe care and treatment and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full 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.