29 March 2023
During a routine inspection
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.