Q Leaf Care Limited

Updated 12 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 two inspectors.

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 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 a registered manager in post.

Notice of inspection

We gave a short period 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 29 June 2022 and ended on 4 July 2022. We visited the location’s office on 29 June 2022.

What we did before the 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. The provider completed a 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 three people who used the service and three relatives about their experience of the care provided. We spoke to four care staff, the nominated individual, registered manager, deputy manager. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included six people's care records and multiple medication records. We looked at 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.

Updated 12 August 2022

About the service

Q Leaf Care Limited is a domiciliary care agency. It provides personal care to people living in their own home. At the time of our inspection there were 20 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. There were 19 people in receipt of personal care.

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

People shared positive feedback regarding their experience with Q Leaf Care Limited. However, we identified that medicines management was not always safe, and the registered manager and provider missed the opportunity to learn from incidents. When new staff started at Q Leaf Care Limited, safe recruitment practices were not always followed, and staff did not always receive training and supervision before working with people. Staff worked with people before they completed core training and competency checks to ensure they had the skills to work with people. When complaints were made there was not a robust system to ensure all the complaint was investigated and responded to, and outcomes were not always upheld by the registered manager. End of life care plans were not always in place. Checks and audits were not robust and effective in identifying the shortfalls highlighted during our inspection.

People and their relatives told us they felt safe when supported by Q leaf Care Limited. A relative told us, “Occasionally I have to pop out, and I feel quite safe to leave staff with my wife. She is in good hands and I wouldn’t leave her with just anyone.” People told us that care was delivered by a consistent staff team, who kept them updated if they were running late and completed all agreed care calls. One person told us, “They give me great confidence. They come four times a day.” Relatives told us staff always wore personal protective equipment (PPE) and followed infection prevention strategies.

People’s needs were assessed before they were supported by Q Leaf Care Limited. People who needed support with nutrition and hydration told us they always received this. When people’s needs changed, or they needed support from healthcare professionals staff offered advice and helped people seek support. 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.

People and their relatives told us they were happy with the support they received. One relative told us, “We are all like a group of friends. We have build up a lot of trust.” Another relative told us, “Without a doubt they are caring. We haven’t come across it before. We live in a building where lots of people get care. A lot of the residents here comment on how polite our carers are. They get such nice feedback.” People told us they had built strong relationships with their staff. A relative told us, “She is definitely treated with respect and dignity. They always ask for a smile.”

People and their relatives told us they received personalised care specific to their needs. One relative told us, “We had to change the care plan quite quickly and I spoke with the management team over the weekend they were so helpful and approachable.”

There was a positive culture within the staff team, that promoted good outcomes for people. People told us their opinions were regularly sought and used to improve the service. Staff told us that the management team were always there to support them.

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.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The registered manager and nominated individual were not aware of the guidance and how to support autistic people and people with a learning disability.

Right support: Model of care and setting maximises people’s choice, control and Independence. People were supported to have maximum choice over their lives and the support they received. Staff were able to demonstrate how they supported people to be as independent as possible.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights. Staff were able to demonstrate how they promoted people’s human rights, and people told us staff always treated them in a dignified way.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. There was a positive culture and ethos set by the registered manager, which supported good outcomes for people. However, systems were not always in place to ensure people received the safest, most effective care.

The registered manager assured us that prior to supporting anyone with a learning disability or someone who was autistic they would ensure that they were able to comply with our guidance.

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

Rating at last inspection

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

Why we inspected

The inspection was in part prompted in part due to concerns received about medicines management, staffing and recruitment. A decision was made for us to inspect and examine those risks. We registered this service on 2 July 2021 and this was the first inspection.

You can see what action we have asked the provider to take at the end of this full report.

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 medicines and learning from incidents, recruitment and checks and audits 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.