Care at Home Group Cheshire West and Wirral

Updated 6 February 2024

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.

Inspection team

The inspection was undertaken by an inspector, a regulatory coordinator and 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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. However, a new manager had been appointed and had submitted an application to register with the Commission.

Notice of inspection

We gave a short period of notice of the inspection because we needed to be sure that the provider or manager would be in the office to support the inspection.

Inspection activity started on 22 November 2023 and ended on 8 December 2023. We visited the location’s office/service on 22 November 2023.

What we did before the inspection

We reviewed information we had received about the service since it was registered, and sought feedback from the local authority and professionals who work with the service. We used the 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 this information to plan our inspection.

During the inspection

During the site visit we spoke with the nominated individual, operations manager and the manager and gained feedback from 3 care staff after the visit. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We received feedback from 13 other staff members. We also spoke with 5 people who used the service and 6 relatives, about their experience of the care provided, and reviewed the information and experiences people shared with us online during the inspection process.

We reviewed a range of records. This included 6 people's care records and a range of people’s medication records. We looked at 4 staff files in relation to safe recruitment. A variety of records relating to the management of the service, including audits, were also reviewed.

Updated 6 February 2024

About the service

Care at home group Cheshire West and Wirral is a domiciliary care agency providing support to people in their own homes. 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. At the time of the inspection, 82 people were in receipt of personal care.

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

Systems in place to monitor the quality and safety of the service were not always effective and did not consistently promote good outcomes for people. Audits did not identify the issues we highlighted during the inspection, and feedback from people regarding the management of the service was not positive. CQC had not been informed of all notifiable incidents, such as safeguarding concerns. Records regarding the service provided, and staff employed, were not always maintained accurately. We were told team meetings had taken place, but these could not be evidenced as they have not been recorded.

Systems in place to manage medicines were not always effective. Although staff had completed medicine training and had their competency assessed, medicines were not always administered in line with people’s plans of care and there were some gaps evident in the recording of medicines administered. We made a recommendation regarding this.

Systems were in place to recruit staff safely, but these were not always completed robustly. The outcome of Disclosure and Barring Service checks were not always clearly recorded within staff files and not all staff files contained a full employment history as required. People told us they did not always receive their calls at the scheduled times. Electronic records did not always provide clear and consistent information regarding call times, as staff did not always log in or out of every call. We made a recommendation regarding this.

Records showed that staff completed an induction, training and shadowing shifts, and completed competency assessments to ensure they had the skills to meet people’s individual needs. However, these tools were not always completed robustly and despite the training recorded, people raised concerns about the knowledge and skills of some staff.

Procedures were in place to ensure safeguarding concerns were managed appropriately and risk assessments were in place to assess and manage risks. People’s care plans were detailed and included clear guidance for staff. Referrals were made to other health and social care professionals if staff had any concerns regarding people’s health and wellbeing and staff supported people to access medical advice and attend appointments when required.

Systems were in place to seek and record people’s consent but could be further improved. Information regarding Power of Attorney (POA) was not always clearly recorded or evidenced. 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.

Most people told us they were treated with respect by staff who supported them regularly and knew them well. However, people also said that newer staff did not know them as well and this impacted on their care experience. People were encouraged to share their views of the service they received and were involved in decisions about their care. Care plans were clear, detailed and reflected people’s preferences in relation to the care they required. They included information regarding people’s medical health needs, to ensure these were known about and could be managed effectively.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 12 April 2022 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, training and the provision of care. A decision was made for us to inspect and examine those risks. As the service had not yet been inspected, a comprehensive inspection was completed. Concerns were identified and you can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified a breach in relation to the governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report. We also made recommendations regarding the management of medicines, and staffing and recruitment.

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

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.