Background to this inspection
Updated
3 November 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 completed by 3 inspectors 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 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.
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 6 July 2023 and ended on 21 July 2023. We visited the location’s office on and 6 July 2023 and 18 July 2023.
What we did before the inspection
We reviewed information we had received about the service since they registered. We sought feedback from the local authority who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We reviewed a range of records. This included 5 people’s care records and medicine records. We looked at 2 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 spoke with 6 people and 4 relatives of people who used the service about their experience of the care provided. We contacted 11 members of staff including the registered manager, nominated individual and care workers.
Updated
3 November 2023
About the service
Care Hearted Oxfordshire Office is a domiciliary care agency. They provide personal care to people living 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 36 people were receiving personal care.
People’s experience of using this service and what we found
People were placed at risk of harm. Systems and processes were not effective in assessing, monitoring and mitigating risks to people. People were not consistently protected against known risks. Risk assessments were not always in place or contained sufficient details to ensure staff had the information to support people safely. Information held about people was not always kept up to date and factual. Care plans were not always reflective of people’s needs.
Medicines were not always safely managed. Information was incorrect, staff did not always have the training required and ‘As required’ medicines did not have protocols in place. Audits were ineffective in identifying the concerns and putting mitigating strategies in place to protect people for harm.
Staff had not always been safely recruited. References had not always been sought and police checks were not always completed before a staff member started to work with people. We could not be assured of the quality of the training delivered to staff.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People told us staff did not always turn up on time or stay the allocated amount of time. Staff had not always completed the tasks required to meet people’s needs. People did not always know which staff were coming to support them.
People were not always supported with dignity and respect. People were not always able to effectively communicate with staff. Information recorded about people was not always documented in professional or respectful language.
People did not always receive person centred care. People and relatives were not always involved in reviewing of care needs, and not all people had seen a copy of their care plan.
People, relatives and staff had made some complaints. However, these were not always dealt with satisfactorily. Not all people and relatives felt able to complain. We made a recommendation regarding complaints procedures.
Oversight of the service was inadequate and failed to ensure safe care and treatment was provided. Audits had not identified the concerns we found on inspection. Lessons had not been learnt and improvements had not been implemented.
The provider and registered manager had not always understood their legal obligations. Notifications required by law had not been submitted to keep people safe.
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 19 August 2022, and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about oversight and staff recruitment.
Enforcement and Recommendations
We have identified breaches in relation to risks, medicines, staff recruitment, staff training, dignity and respect, consent and management oversight at this inspection.
You can see some of the action we have asked the provider to take at the back 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 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.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.