We carried out a review of the data available to us about Choose Your Care on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Choose Your Care, you can give feedback on this service.
People’s experience of using this service:
People told us they felt safe and staff knew how to identify and report concerns relating to people’s safety. Risks were assessed and managed to reduce the risk of avoidable harm. People received support to take their medicines safely. People received timely support by a consistent staff team.
Decisions about people’s care and treatment were made in line with law and guidance. People received sufficient amounts to eat and drink to maintain their health. Staff received training relevant to their role and understood people’s individual needs well.
People were supported by a caring and compassionate staff team. People were supported to maintain their independence and their dignity was valued and respected.
People were supported by a staff team who understood their needs and preferences. People and those close to them were involving in the assessment and planning of their care. People knew how to raise a concern if they were unhappy about the service they received.
People, relatives and staff felt the service was well managed. The registered manager and provider had made improvements since the last inspection. People and staff were given opportunities to share their views about the service. The registered manager and provider carried out regular auditing to ensure the quality of care provided.
Rating at last inspection: The service was last inspected on 26 March 2018 and rated Requires Improvement. At this inspection we found improvements had been made and the service is now rated Good.
Why we inspected: This was a planned inspection based on the rating from our last inspection.
Enforcement: No enforcement action was required.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
During this inspection the service demonstrated to us that some improvements have been made and it is no longer rated as inadequate in well-led. Therefore, this service is now out of Special Measures. We will keep the service under review to ensure improvements continue.
This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults, people with a physical disability and people with dementia. At the time of our inspection the service was supporting approximately 54 people receiving support.
There was a Registered Manager in post at the time of our inspection. 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.
The principles of the Mental Capacity Act (2005) were not always being followed, but some improvements had been made since the last inspection.
Quality monitoring systems were not always effective in identifying omissions but new systems were being introduced.
Overall people felt there were enough staff to meet their needs and staff felt their rotas were manageable. Staff were recruited safely and appropriate checks were carried out.
People told us they felt safe. Risk assessments and plans were in place to guide staff and staff knew people’s needs.
People were appropriately supported with their medicines.
Infection control measures were in place and people told us staff used appropriate personal protective equipment.
Actions had been put in place when things had gone wrong to try to reduce the likelihood of a similar incident occurring.
People were asked for their consent prior to being supported by staff.
People and relatives felt staff were well-trained and staff felt supported to carry out their role effectively.
Assessments took place to ensure the service could support people and plans of care were developed.
People were supported to eat and drink sufficient amounts.
People had access to other health professionals when necessary.
People all told us they were treated with dignity and respect whilst being supported to maintain their independence. People could make decisions about their own care.
Staff knew people well and care plans had personal details so staff could get to know how people liked to be supported.
People knew how to complain and felt able to. Complaints had been responded to where necessary.
The service had considered what support people might need near the end of their life.
People were asked for their opinion about their care and found the registered manager and staff approachable. Staff felt supported by the registered manager.
Notifications were submitted where necessary.
We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found that improvements had been made in relation to two of the four previous breaches, so those regulations were no longer being breached. However, we identified two continued breaches and one additional breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. You can see what action we told the provider to take at the back of the full version of the report.
During this inspection the service demonstrated to us that some improvements have been made and it is no longer rated as inadequate overall however one of the key questions still has a rating of inadequate. Therefore, this service is still in Special Measures.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
The office inspection took place on 26 April 2017, with follow up phone calls to people, relatives and staff following this. We gave the provider 48 hours’ notice. This was to ensure that someone would be available in the office as it is a domiciliary care service. At the time of our inspection there were approximately 47 people using the service with a range of support needs such as people living with dementia, physical disability and older people.
There was a Registered Manager in post at the time of our inspection. 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 were not always protected from alleged abuse as some concerns had not been reported to the management and the local safeguarding authority for them to look into.
Guidance was not always available for staff to follow to protect some people’s skin integrity.
People’s medicines were not always managed safely as there were not always instructions available for staff to follow and there were not always explanations when medicines had not been administered.
People were not always protected from the risk of cross infection/contamination. Infection control measures were not always in place.
Although training had been improved since our last inspection, more improvement was required, particularly regarding the identification of safeguarding concerns and specific health conditions.
The principles of the Mental Capacity Act 2005 (MCA) were not always followed as people who may not have had Lasting Power of Attorney (LPOA) were signing consent on behalf of people. However, mental capacity assessments were now being carried out to help determine if people had capacity to make decisions.
People told us they felt they were treated with dignity and respect. However, we received feedback that people preferred to have regular staff and this was not always being offered and people did not feel their care was as personalised with non-regular staff.
People told us they felt that their feedback was not always acted upon to make improvements to their experience of care.
People and relatives told us they knew how to complain and improvements had been made since our last inspection regarding responding to complaint. However, further improvements were still required as some people did not feel their feedback was being responded to and issues not always been resolved.
Audits were now being carried out and whilst some had identified issues, some actions had not been completed and further work was required to ensure the improvements continued
The registered manager had been submitting notifications about the service, which they are required to do.
People told us they felt safe and their relatives confirmed they felt their loved ones were safe when being supported by staff.
Guidance was in place for staff regarding moving and handling, which had not been in place previously. These matched what people and relatives told us and what staff were recording in care notes.
People, relatives and staff told us there were enough staff. Safe recruitment practices were in place and staff had appropriate checks prior to starting work to ensure they were suitable to work with people who use the service.
People were supported with their nutritional intake when necessary, although most people were supported by their loved ones.
People had access to health care services and were supported by staff where required. Changes in people’s health were also reported to relatives.
People, relatives and staff knew who the registered manager was and felt able to go to them with queries.
There was no registered manager in post at the time of our inspection. 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 identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
The service was not consistently safe. There were safeguarding incidents that we were made aware of that had not been reported to the local safeguarding authority in order to protect people who used the service. Not all staff were aware of what constituted abuse and not all staff had undertaken safeguarding training. Staff had not always recognised when abuse was occurring.
Risk assessments lacked detail and often there were no mitigating plans in order to reduce the risk for people and staff. Some people had support needs which had not been taken into account in the risk assessments, such as equipment used for mobilising and help to keep skin healthy.
Medicines were not always managed safely. People who required support with their medicines did not always have this recorded within their care plan and risk assessments and there was information missing from some medicine records so there was a risk of staff not giving medicines as prescribed. There were also no protocols in place for medicine that were ‘as and when required’ (PRN) so this put people at risk of not having their medicines when they needed them.
There were not always enough staff so that people received the amount of support they needed, with staff they knew and at the time they expected. Some calls had been planned to take place at the same time and date as other calls so staff were expected to be undertaking two visits at the same time on occasion.
Staff were not always sufficiently trained. New staff did not have a formal induction process and were taught whilst accompanying other staff members whilst out on calls. Staff told us they did not feel that the training they had received was enough to help them be effective in their role to care for people safely and well. This also did not equip them with the skills to provide training for new staff members.
Plans were not in place to provide guidance for staff about how to manage behaviours associated with caring for people who became anxious when support was provided. This put both people and staff at risk as staff were not always aware of how to support people effectively.
Staff did not feel fully supported in their role and not all had received supervisions to ensure they were effective in their role. Staff had limited opportunities to discuss their own training and development needs.
Mental capacity assessments were not consistently carried out and some of those that had been carried out had not been completed correctly. Checks regarding relative’s legal authority to make decisions on a person’s behalf had not been made so people’s legal rights were not being protected. People and staff confirmed that people were supported to make their own decisions and consent was gained before staff gave support. Therefore not all of the principles of the Mental Capacity Act 2005 (MCA 2005) were being consistently followed.
People told us they were regularly asked for their opinion about the service they received but they often would not get a response or the concerns they had raised would not be addressed. Therefore improvements were not made based on feedback from the people who used the service.
Concerns were not always reported by staff and the service had not identified these issues through their quality monitoring systems. Quality monitoring systems were not fully implemented and minimal auditing had taken place. Although some issues had been identified, they had not yet been addressed.
People and relatives did not always know who the manager was and felt they had not always responded to feedback. People told us they knew who other senior members of staff were at the service and they were able to approach them.
People found staff treated them with dignity and respect and when people had regular staff that visited them, they were able to build up a relationship as staff got to know them. However, people were often visited by staff they did not know and care plans lacked detail to support these other members of staff to meet people’s preferences. People told us that they were encouraged to be independent and staff would explain the support they were offering, so people knew what was happening, as it was happening.
Recruitment practices meant that appropriate checks were in place to ensure staff were fit to work with people who used the service. This involved checking with the Disclosure and Barring Service (DBS) for criminal records, getting references from previous employers and checking identity documents.
Most people we spoke to were supported by relatives to make their meals throughout the day.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.