Background to this inspection
Updated
15 February 2023
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 conducted by one inspector. After the inspection, an Expert by Experience supported the inspection by making phone calls to people who used the service and their relatives to ask for their feedback. 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 and flats.
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 a registered manager in post. However, they were not present during the inspection.
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 28 November 2022 and ended on 26 January 2023. We visited the location’s office on 30 November 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection, including notifications of significant events. We used all of this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We took this into account in making our judgements in this report.
During the inspection
We spoke with the care manager and we reviewed a range of records. This included 5 people's care records, 5 staff records and multiple medicines records. A variety of records relating to the management of the service, including audits were also reviewed. As part of the inspection we spoke with 1 person using the service and 11 relatives. 2 of the 13 care workers we emailed to get feedback of their experience of the service responded to us.
Updated
15 February 2023
About the service
Signet Healthcare Limited is a domiciliary care agency providing personal care and support to people living their own homes. At the time of our inspection there were 53 people using 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
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
During the inspection we found risk assessments were not always robust enough and medicines were not always managed safely. Safe recruitment practices were not always followed.
The provider had procedures for managing incidents, accidents, safeguarding alerts and complaints, and quality monitoring processes in place, to help monitor and improve service delivery. However, these were not always effective, as they had not identified the areas where improvements were required that we found during the inspection.
People were not always supported to have maximum choice and control of their lives and the provider could not demonstrate people were always supported in their best interests. While the provider had policies and systems, these were not always robustly implemented.
We have made a recommendation for the provider to consider current guidance around recording in a person centred way.
Notwithstanding the above, people were satisfied with the care provided and felt safe. Staff received appropriate training to meet people’s care needs. People were supported by the same staff which provided consistency.
People using the service, their relatives and staff told us the management team were approachable and had responded to complaints.
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 16 May 2018).
Why we inspected
This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. 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, responsive 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 Signet Healthcare Limited on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment, consent to care, good governance and staffing 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 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.