Carers Choice

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.

Not everyone using Carers Choice receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service is run by a registered manager who was present at the inspection visit to the office. 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.

This announced inspection took place on 15 August 2018.

People received safe care and treatment. Potential risks to people’s health and well-being were assessed and strategies were in place to minimise their impact on people. Staff felt confident to recognise and report any safeguarding concerns. Suitable arrangements were in place to prevent and control infection.

Recruitment practices were effective in making sure that people were supported by staff who were competent and suitable. Staffing numbers were directed by the needs of people using the service to make sure that their individual needs were accommodated.

Care was delivered in a way that promoted positive outcomes for people. Staff had the knowledge and skills they needed to provide support in line with legislation and guidance. This included specific training in how to support people to eat.

People’s health care needs were assessed and met including any assistance people required to take their medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff treated people with kindness and promoted people dignity. People had been supported by consistent staff and positive relationships had been developed. Staff knew how to communicate effectively with people. People had been helped them to express their views and to be actively involved in making decisions about their care as far as possible.

People received person-centred care that promoted their independence. Each care package was developed around the individual needs of the person and their main carers. People were given opportunities to pursue their specific hobbies and interests.

Suitable arrangements were in place to monitor the quality of the service so it could learn, improve and assure its sustainability. People's view and experiences were sought and acted on so that people felt that they were really listened to. This included processes being in place to resolve any complaints received to improve the quality of care. The registered manager was approachable and communicated regularly with people, their carers and staff.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we talked with said 'I could not do without the service they provided, staff are extremely helpful, caring and they treat us with respect. Another person said, 'I feel my son is in safe hands, the staff are wonderful'. Other carers comments included 'This is an excellent service', 'the priority is always the person who used the service' and 'I am very happy with the support we get.' This meant that the care and support being provided was meeting peoples' needs.

There were effective recruitment and selection processes in place. The provider kept satisfactory documentation for all staff to evidence relevant qualifications and a full employment history with satisfactory written explanation of any gaps in employment.

We looked at records and found that the provider was asking for feedback. We saw that quality monitoring questionnaires were sent to out to people who used the service annually and that the results were analysed by the provider.

There was an effective complaints system available.

We saw that peoples' needs had been assessed, with support and treatment planned and delivered in line with individual plans. We saw that assessments were used to ensure safety and welfare.

People and their families were encouraged to be involved in how their support plans were developed.

We spoke with four people and their relatives. All comments were positive. People told us they were included in the planning of their care. One person told us 'the staff provide an excellent service'.

Staff we spoke with were caring and responded to people's needs. Staff were knowledgable about people's support needs and treated people respectfully. Staff told us they felt supported by the service and received regular, quality training.

People who use the service were protected from the risk of abuse because the provider had taken all reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff were knowledgeable about keeping people safe. People told us they felt safe and confident to talk to staff if they had any concerns.

Complaints and concerns were listened to and acted upon immediately.