Carers Choice

Updated 23 August 2022

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 carried out by one inspector and an Expert by Experience on the first day and by an inspector and inspection manager on the second day. 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 houses, flats and in the community.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. The nominated individual and another manager had submitted their application to be registered as a manager with the CQC. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 14 June 2022 and ended on 7 July 2022. We visited the office location on 14 June 2022 and 7 July 2022.

What we did before 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. We did not receive any feedback. 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

We spoke with nine relatives and two people who used the service about their experience of the care provided. We spoke with seven members of staff including the nominated individual, a manager, support workers and administrator. We reviewed a range of records. This included 19 people's care records, and four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We looked at training data sent. We received clarification about service provided from the local authority.

Updated 23 August 2022

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.

About the service

Carers Choice is a domiciliary care agency. It provides personal care to people living in their own houses, flats and when out in the community. The main purpose of this service was to offer activities to people outside of their home, as respite for families. The service provides minimal personal care tasks mainly in the community. At the time of our inspection, 19 people with learning disabilities, autism and physical disabilities were receiving personal care.

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

Although people told us they feel safe and comfortable with staff visiting them, we found that people were not always sufficiently protected from the risk of harm because care plans and risk assessments did not always give enough information to support people safely.

The service was not able to demonstrate fully how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support:

Improvements were needed to reviewing and actioning accidents, incidents and lessons learned. There were no detailed guidelines in place for staff and no improvement plan in place after an incident had occurred to enable right support to be put in place.

Staff were delivering some aspects of care which care commissioners had not requested. This placed people at risk because if commissioners were not aware of what staff were delivering, they could not advise or have external oversight.

Staff supported people to take part in activities and pursue their interests in their local area.

Right Care

The provider had not carried out appropriate risk assessments as at when required. There were no risk assessments for people’s identified specific health and care needs. This placed people at risk of harm.

The provider had not worked well with other agencies. The provider had failed to report choking incidents appropriately to the Local Authority Safeguarding Team. However, staff understood how to protect people from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people's needs.

People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities.

Right culture

The provider did not have adequate processes in place to monitor the safety and quality of the service. There were no quality audits of staff recruitment, risk assessments, care records, medicines and incidents and accidents. There was a lack of management knowledge about regulation and regulatory requirements.

Although there were procedures in place in relation to the Mental Capacity Act 2005 (MCA 2005) that included the steps staff should take to comply with legal requirements. The nominated individual had a limited understanding of the MCA 2005 to enable them to protect people’s rights. Care plans and documentation did not evidence that the MCA 2005 had been followed. We found no MCA assessments for people supported.

People were supported by staff who had not been fully trained in certain care related areas. However, staff demonstrated some knowledge in relation to the impairments or sensitivities people with a learning disability and/or autistic people may have.

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 good (published 07 September 2018).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to the management and leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections 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 Carers Choice on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.