Background to this inspection
Updated
6 July 2021
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 Care Act 2014.
Inspection team
The inspection was carried out by two inspectors. Telephone calls to people and their relatives were made by an Expert 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 service is a domiciliary care agency. It provides personal care to people living in their own homes.
The service did not have a manager registered with the Care Quality Commission. Where a registered manager is in place, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. There was a new manager in place who had taken up the role eight weeks prior to the inspection. The new manager would be applying to become the registered manager of the service.
Notice of inspection
This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or manager would be in the office to support the inspection.
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 prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with eight people who used the service and ten relatives about their experience of the care provided. We spoke with seven members of care staff including the manager. We reviewed a range of records. This included six people’s care records. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records including competency checks for staff, daily recordings, staff supervision documents and the staff rota.
Updated
6 July 2021
About the service
Carepoint t/a Alternative Care is a domiciliary care service providing personal care to people with a variety of needs including dementia, physical disability and sensory impairment. Older people and younger adults, including people with learning disabilities and/or autistic spectrum disorder.
People are supported in their own homes, at the time of this inspection, 183 people were receiving personal care from the service.
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;
At our last inspection the registered manager had failed to ensure systems and processes related to safeguarding were established and operated effectively to investigate, immediately upon becoming aware of any allegation or evidence of such abuse. At this inspection we found improvements had been made and that concerns were being responded to as required. Staff had received safeguarding training and understood processes to report concerns.
It was previously found that people may be at risk by lack of information related to gaps in work history of staff during their application. During this inspection we found that not all work history or references had been taken appropriately. The new manager informed us they had plans to introduce the requirement for whole work history to be taken to ensure that there was no gap in information provided by staff.
During the previous inspection we also found that systems were not in place to manage safety and quality effectively. Complete, accurate and contemporaneous records were not kept to ensure good governance. At this inspection we saw that the new manager had started to bring together information to have an oversight of the service, however not all concerns had been identified effectively. Some risk assessments were in place, but where new concerns had arisen additional risk assessments had not always been implemented.
We found that although there had been previous medicines errors and missed medicines there were actions being taken by the manager to minimise these. However, records for medicine administration were not always completed appropriately.
Care plans were detailed, and person centred. People had been involved in their completion and updating. Staff were aware of information held within care plans and risk assessments.
People were happy with the service they received. People did not experience missed calls nor a high number of late calls. The manager was aware that weekends were sometimes more problematic when ensuring staff arrived on time and was dealing with this to minimise any disruption to people using the service.
People felt safe when staff attended to them and confirmed staff wore PPE (personal protective equipment) when entering their home and supporting them. People felt supported safely by a consistent staff group.
Staff worked in partnership with external healthcare professionals to ensure people’s healthcare needs were met.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 23 May 2019) and there were breaches of regulation within the safe and well led domains. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of regulation 13, however they were still in breach of regulation 17.
Why we inspected
We received concerns in relation to the management of medicines and lack of registered manager. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the well led section 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 Carepoint t/a Alternative Care on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.