We carried out a review of the data available to us about Carers 4 U Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Carers 4 U Ltd, you can give feedback on this service.
About the service
Carers 4 U Ltd is a domiciliary care agency. It provides personal care, support and live in care services to adults and older people living within their own homes. At the time of our inspection there were 33 people using the service.
Not everyone using the service may receive the regulated activity; personal care. 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.
People’s experience of using this service and what we found
Records were not always updated after care and support reviews. Where things went wrong lessons were not always learnt promptly from complaints to prevent repeat occurrences. People, their relatives and staff views were gathered, and the results were analysed but there were no action plans in place to help drive improvements.
People and their relatives said they felt safe using the service. Staff understood the need to protect people in their care from the risk of abuse and knew how to raise any concerns of abuse. Risks to people's health and safety had been identified and assessed. People's medicines were managed safely, and people were protected from the risk of infections and diseases. Staff were effectively deployed to ensure people’s needs were met. The service followed appropriate pre-employment checks before staff started working with the service. Accidents and incidents were recorded and reported.
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.
Before people began using the service their needs were assessed to ensure they could be met. People were supported to maintain good health; eat healthily and access healthcare services when required. People knew how to make a complaint if they were unhappy about the service. Care and support was planned and delivered to meet individual needs and people’s communication needs were assessed and met.
The manager understood their responsibility for meeting regulatory requirements. Feedback from staff about the culture and the way the service was managed was positive. The service worked in partnership with key organisations to deliver an effective service.
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 requires improvement (published 3 October 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance. At this inspection we found improvements had been made, however, this was not enough, and the provider is still rated requires improvement under the well-led key question.
Why we inspected
This was a planned inspection based on the previous rating. We carried out an announced comprehensive inspection of this service on 26 July 2019, where breaches of legal requirements were found. We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carers 4 U Ltd on our website at www.cqc.org.uk.
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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Carers 4 U Ltd is a domiciliary care agency. It provides personal care, support and live in care services to adults and older people living within their own homes. Not everyone using the service may receive the regulated activity; personal care. 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. At the time of our inspection there were approximately 33 people using the service.
People’s experience of using this service
The provider had failed to ensure risks to people were appropriately assessed, recorded and managed by staff to avoid possible harm. The systems and processes in place for managing people's medicines were not always safe. Policies and procedures in place for reporting and recording accidents and incidents were not always robust to ensure peoples safety and were not conducive to learning from incidents. The providers electronic call monitoring (ECM) system was not robust or monitored to ensure people did not receive late or missed calls which potentially placed them at risk.
The provider failed to assess people’s capacity in line with the MCA and maintain a record of decisions made in people's best interests. People were not supported to have maximum choice and control of their lives and staff did not 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. We have made a recommendation about ensuring the provider follows the principles of The Mental Capacity Act (2005).
Health and social care assessments were basic and lacked important information and guidance for staff. We have made a recommendation that the provider develops a more thorough and detailed tool for assessing individual’s needs, to ensure the staff team have a clear picture of individual’s needs, preferences and wishes and how best these can be met.
Peoples end of life care and support need and wishes were not assessed or documented as part of their plan or care. We have made a recommendation that the provider develops a detailed assessment tool for assessing individuals end of life care needs and wishes should people wish to do so and how best these can be met in line with good practice guidance.
The provider's quality assurance and monitoring systems had failed to identify the concerns we found at this inspection.
People and their relatives spoke positively about the care and support they received. Staff communicated well with people and had built good relationships with them. Professionals feedback was positive confirming good partnership working.
Safeguarding and whistleblowing policies and procedures were in place and staff were aware of how to keep people safe. Arrangements were in place to prevent the spread of infections. Appropriate recruitment checks took place before staff started work and there were sufficient staff available to meet people's needs. Staff had the skills and knowledge to support people appropriately. Staff were supported through induction, training and supervision.
People were supported to maintain a healthy balanced diet where this was part of the planned care. People and their relatives were involved in planning for their care and support. People had access to health and social care professionals as required and were supported to access community services.
Staff worked with people to promote their rights and understood the Equality Act 2010; supporting people appropriately addressing any protected characteristics. The service worked well in partnership with health and social care professionals.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 31 January 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
At this inspection we rated the service as requires improvement. We identified two breaches of regulations, in relation to safe care and treatment and good governance. Please refer to the end of the report for action we have told the provider to take.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. The service will be re-inspected as per our inspection programme. We will continue to monitor any information we receive about the service. We may bring the next inspection forward if we receive any concerning information.
At this inspection we found that the provider had taken action to make sure that records relating to staff supervisions and annual appraisals were kept up to date.
The service had a registered manager in post. 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 and associated Regulations about how the service is run.
People said they felt safe and staff treated them well. The service had appropriate safeguarding adults procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Procedures were in place to support people where risks to their health and welfare had been identified. Appropriate recruitment checks took place before staff started work. People’s medicines were managed appropriately and people received their medicines as prescribed by healthcare professionals.
The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they had received training relevant to the needs of people using the service. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.
People were provided with appropriate information about the service. People and their relatives said staff were kind and caring and their privacy and dignity was respected. They had been consulted about their care and support needs and care plans were in place that provided information for staff on how to support people to meet their needs. People were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.
The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through satisfaction surveys. The provider carried out unannounced spot checks to make sure people were supported in line with their plans of care. Staff said they enjoyed working at the service and they received good support from the registered manager and care coordinators.
The service had a registered manager in post. 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 and associated Regulations about how the service is run.
A breach of legal requirements was identified. The provider did not always keep up to date records of the staff supervision sessions or annual appraisals. You can see the action we have asked the provider to take at the back of the full version of the report.
The provider did not have a call monitoring system in place that ensured staff turned up to support people or stayed for the allotted time to provide care. We saw the manager and a care coordinator contacting people using the service and staff throughout the course of our inspection, making sure people received care when they were supposed to. The provider was currently looking at the different call monitoring systems available with a view of adopting a call monitoring system for the service. We were not able to assess the impact of the lack of a call monitoring system on people's care as the system was not in place at the time of inspection. We will assess this at our next inspection of the service.
People said they felt safe and staff treated them well. The service had appropriate safeguarding adults procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work. Where appropriate people were supported to take their medicines as prescribed by health care professionals. There was a whistle-blowing procedure available and staff said they would use it if they needed to.
The manager had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they were up to date with their training. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.
People had been consulted about their care and support needs. Care plans and risk assessments provided information for staff on how to support people to meet their needs. People were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.
The provider took into account the views of people using the service through satisfaction surveys. The provider carried out unannounced spot checks to make sure people were supported in line with their care plans. Staff said they enjoyed working at the service and they received good support from the manager. They said there was an out of hours on call system in operation that ensured management support and advice was always available when they needed it.