We carried out a review of the data available to us about Homecare Plus Limited 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 Homecare Plus Limited, you can give feedback on this service.
About the service
Homecare Plus Limited is a domiciliary service providing personal care to people living in their own homes throughout Tyne and Wear and Northumberland. Services were provided to adults with a wide range of health and social care needs including physical disabilities, learning disabilities, mental health needs and dementia. At the time of our inspection there were 253 people receiving a 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
People were provided with care and support in a safe environment. Safeguarding procedures were embedded within the service and incidents and accidents were reported and analysed.
There were enough suitably recruited staff on duty. Staff were kind and caring and the care provided was centred around people’s individual needs.
Infection control procedures were being followed and any issues arising were addressed straight away. Enough masks, aprons and gloves were available for staff to use.
People and staff reported the service was well led. We did receive some mixed comments on poor communication which was raised with the management team to investigate.
Medicines management procedures were in place and were updated during the inspection due to some issues we found. People did not report any concerns with their medicines. We made a recommendation to further review medicines management procedures.
There were quality assurance systems in place to monitor the service and care being provided. Some records and quality assurance processes would benefit from further review. The provider was in the process of updating records. We have made a recommendation to review quality assurance systems.
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.
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 21 February 2018).
Why we inspected
This was a planned pilot virtual inspection. The report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the provider.
The pilot inspection considered the key questions of safe and well-led and provide a rating for those key questions. Only parts of the effective, caring and responsive key questions were considered, and therefore the ratings for these key questions are those awarded at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Homecare Plus Limited on our website at www.cqc.org.uk
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.
Not everyone using Homecare Plus receives regulated activity; The Care Quality Commission (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 had a registered manager in post. The registered manager has been in post since the service first registered in September 2014. A registered manager is a person who has registered with the CQC 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.
At the last inspection in April 2017 we asked the provider to take action to make improvements to the safety of the service, safeguarding people, staff recruitment, management of complaints and the governance of the service. We found these actions had been completed.
People told us they felt safe and comfortable with the staff who visited their home on a regular basis. Policies and procedures were in place to assist staff to safeguard people from harm and abuse and the staff we spoke with understood their responsibilities with regards to protecting people. Incidents of a safeguarding nature had been appropriately investigated, reported, recorded and monitored. Two local authority safeguarding teams told us that following a period of close monitoring they had no current concerns about the service.
Care workers supported people to maintain their health, safety and welfare within their own home. Risk assessments had been carried out where individual risks had been identified. We saw these were regularly reviewed and updated when people’s needs changed.
Staff felt there were enough of them employed at the service to look after people safely and to meet their needs. Care workers said they had not felt rushed in recent months and improvements had been made to how they were deployed. People told us that overall they had regular care workers who were reliable and punctual.
Staff recruitment had been reviewed and stringent procedures were now followed. The process was safe, fair and robust. New staff had received a comprehensive induction and staff training was up to date. Records showed and staff confirmed that they had regular supervision sessions, annual appraisal and staff meetings in order to voice their opinions, share feedback, discuss any issues and make additional requests to develop their skills and knowledge. Staff told us they felt valued by the management team and that there was an open and honest culture, whereby they did not feel afraid to discuss anything and they could be sure the registered manager would act upon their feedback.
People told us they received their medicines in a safe manner and when they expected it. Competency checks on care workers were completed to ensure they remained competent at administering medicines and regular unannounced spot checks were conducted to ensure the high standards of service which the registered manager expected continued to be delivered. Medicine administration records had been reviewed and significantly improved since our last inspection.
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.
Care workers encouraged people to maintain a healthy and balanced diet. People told us their care workers made meals of their choice in line with their likes and dislikes and respected their preferences. Dieticians and other external health professionals were involved with people’s care to ensure their ongoing well-being.
The people and relatives we spoke with told us that care workers were friendly and professional and that they respected their home and their belongings. People said staff upheld their dignity and privacy. The staff we spoke with all displayed caring and considerate attitudes and spoke passionately about their role.
There was a complaints policy in place; this has been reviewed and re-issued to staff to ensure they were aware of their responsibility to escalate matters to the registered manager as necessary. We saw all complaints and minor issues had been logged, investigated and resolved in a timely manner. People we spoke with had no complaints about the service.
The staffing structure had been strengthened with the introduction of additional roles within the office and additional duties for senior care workers to ensure that the monitoring of the service was methodical and in-depth. We saw audits of the service had been reviewed; existing audits had been improved and new audits had been implemented. These audits demonstrated that checks on service delivery were systematically undertaken and where issues were identified, they were referred to the registered manager for action. There was now a dedicated role in the office to oversee safeguarding incidents, complaints and governance to make sure these were effectively and correctly dealt with.
A customer survey had been carried out in July 2017 and the results showed that people who used the service and their relatives were satisfied with the service they received. Our pre-inspection questionnaire responses corroborated this.
There was an established staff recognition scheme in place. We saw that staff were invited to nominate each other for monthly awards and care workers were also rewarded when compliments about their work was received from people whom they cared for.
Our last inspection of this service took place in December 2015 when the service was rated overall as Good. The requirements of all of the regulations that we inspected at that time were met. At this inspection the service was rated overall as Requires Improvement due to identified shortfalls in a number of regulations.
This inspection took place on 5, 26, 27 and 28 April 2017. We did not announce the inspection on the first day that we visited, as we carried out the inspection in response to multiple concerns that had been shared with the Commission in the weeks prior to our visit by a range of people, some of which were anonymously shared. The visits on the 26 and 27 April 2017 were announced. On 28 April 2017 we gathered further evidence by speaking with people who used the service, their relatives and staff.
A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since September 2014. 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. The registered manager was also the nominated individual and a director of the provider company.
People were not appropriately safeguarded from abuse or improper treatment because staff did not always recognise or report matters of a safeguarding nature for assessment and potential investigation by the local authority safeguarding adults team. Information was shared with the Commission prior to our inspection that identified concerns around the registered manager's handling of a particular safeguarding matter. When we reviewed this incident at the service we found that previous linked concerns had not been investigated and referred to the local authority safeguarding adults team at the first available opportunity. The registered manager had carried out their own undocumented investigations. When we reviewed complaints and other records within the service we identified other matters of a safeguarding nature that staff had not alerted to the registered manager and additionally concerns that the registered manager had not escalated in line with safeguarding protocols.
Medicines were not managed safely. Care plans about medicines were not in place and there was a lack of information about where the service's responsibilities with medicines started and ended. We found multiple gaps in recording on Medicines Administration Records (MARs). We could not reconcile whether people had received and taken their medicines as prescribed. Care calls were not always planned to allow for sufficient time gaps between medicines administrations and staff said they had to rely on themselves picking this up as an issue. Topical administration records for creams or ointments applied to the skin were not fully completed and they were not appropriately maintained.
Recruitment processes and procedures were not robust. Appropriate vetting checks were not always carried out and recruitment was not always impartial. One staff member had only had a basic Disclosure and Barring Service (DBS) check done as opposed to an enhanced one, as per the provider's own policy.
We received mixed feedback about staffing levels and could not establish if staffing levels were too low, or if the deployment of staff was not appropriate due to poor organisation around rotas. Staff also received no time built into their rotas for travel time and this resulted in them being late for care calls. We have made a recommendation about this.
Risks were assessed and reviewed monthly. Plans about how to manage identified risks were built into care plans. Accidents and incidents were recorded but we could not always establish if actions had been taken to follow up any issues.
People said they were happy with the standards of care they received and the caring nature of the staff team. People told us they enjoyed good relationships with staff, they were treated with dignity and respect and they were encouraged to be as independent as possible.
People's nutritional needs were met and care monitoring tools were maintained to identify any changes in people's needs such as an increase in incontinence or decrease in food and fluid intake. People were supported to access general medical support and also more specialist support as and when needed.
CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The service assessed people’s capacity when their care commenced and on an on-going basis when necessary. The registered manager told us that no person currently using the service had needed a best interest decision to be made on their behalf. Records around initial capacity assessments and those undertaken on an on-going basis needed to be improved to better evidence application of the Act.
Staff received training in most key areas although there was some evidence to suggest that this was not always applied in practice. We have made a recommendation about this.
Supervisions and appraisals took place regularly and an induction programme was undertaken by new staff when they started in post. Communication within the service was poor and the registered manager told us this was something that she needed to address.
Care records were not appropriately maintained and did not contain all relevant information about people's needs. Some information in people's care records was inaccurate or out of date. Care plans were reviewed as were risk assessments, but during these reviews amendments were not made to incorrect paperwork. Other records and record keeping across the service were poor.
People told us complaints they had made had not been responded to appropriately and the registered manager confirmed this in our discussions with her. Responses and records were not maintained in line with the provider's own complaints policy.
Some audits and checks were carried out but these were not always effective in identifying concerns or shortfalls such as those highlighted in these inspection findings. Where shortfalls were identified it was not clear what action had been taken to address these as action plans were not used to drive through and track progress of improvements. The registered manager did not have a robust oversight of the business and she did not always apply the provider policies correctly.
People and staff were positive about the registered manager saying they were a nice person and keen to help. The registered manager told us she was committed to rectifying the shortfalls that we had identified and was keen to work with the Commission to drive through the necessary improvements.
We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 namely: Regulation 12 Safe care and treatment; Regulation 13 Safeguarding service users from abuse and improper treatment; Regulation 16 Receiving and acting on complaints; Regulation 17 Good governance; and Regulation 19 Fit and proper persons employed. You can see the action we have told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Home Care Plus is a domiciliary care service providing personal care and support to people living in their own homes, in the North Tyneside and Newcastle areas. The service provides general care but also specialises in supporting people with complex health needs and end of life care. At the time of our inspection there were 62 people using the service. The service has a mix of local authority and privately funded people.
This inspection took place on the 2 and 3 December and was announced. This was our first inspection of the service since it was registered in October 2014.
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 2008 and associated Regulations about how the service is run.
People spoke highly of the registered manager, office staff and the care workers who supported them to live at home. People told us they felt safe and comfortable with the care workers who visited their homes and that they trusted the provider to deliver a good service. Policies and procedures were in place to safeguard people from harm or abuse and staff understood their responsibilities. Records were kept regarding safeguarding concerns and investigations had taken place in a timely manner. The registered manager had reported all incidents of a safeguarding nature to the local authority safeguarding adult’s team.
Staff supported people to manage health and safety in their home and care records showed that risks associated with individual care needs had been assessed and were monitored. There was evidence to demonstrate that regular reviews were carried out and the information was passed onto the care workers and other agencies when necessary.
Staff told us they felt there was enough people employed by the service to manage it effectively and to meet people’s needs. People told us that they didn’t feel rushed and that staff sometimes have time for a cup of tea and a chat before they had to leave. Staff files showed the recruitment process was robust and staff had been safely recruited. Training was up to date, and care workers had a mix of skills and experience. Some staff had qualifications in health and social care and opportunities were available for them to progress and further their knowledge in a wide variety of topics such as palliative care and challenging behaviour.
The registered manager and coordinators carried out regular staff supervision and appraisal meetings which were documented. Staff meetings were also held regularly and minutes were recorded. This demonstrated an open culture of communication where staff had the opportunity to speak to the management. Competency checks were undertaken by senior care workers to assess the staff’s suitability for their role. Checks relating to handling medicines showed care workers were competent with this task and people told us they received their medicines in a safe and timely manner.
There was evidence to show the staff understood their responsibility and they assessed people’s capacity when their care commenced and reviewed it as necessary. Decisions that were made in people’s best interests’ had been appropriately taken with other professionals and relatives involved.
People were supported by staff to maintain a balanced diet. People told us the staff made good meals and always offer them a choice. One person told us “My care worker is exceptional – she is fantastic.” Staff had undertaken equality and diversity training and people told us that they were treated as an individual and staff took time to understand their likes and dislikes.
Staff displayed caring and compassionate attitudes and people told us the office staff and care workers go above and beyond what is expected of them. All the people we spoke with said they were treated with dignity and respect and that staff were pleasant and friendly towards them and their families. A relative told us “It’s a good service, it makes life easier. X (relative) has complex needs; it’s hard getting used to people coming into your home so much – but everything is fine now.”
The registered manager held information relating to complaints, accidents and incidents. There was a complaints policy in place and evidence showed complaints had been dealt with appropriately and in a timely manner. Management action had been taken to resolve issues and in some cases disciplinary action had taken place. People told us they knew how to make a complaint and they would have no hesitation in contacting the registered manager or the coordinator should they need to. One person said, “There was one care worker I didn’t gel with, but I told them (office staff) and they sorted it straight away.” Another said, “I’ve had a couple (care workers) who weren’t suited to the job; they don’t come anymore though.”
The service was proactively monitoring the quality of the service. Senior care workers carried out spot checks of care workers and the office staff regularly courtesy called their ‘customers’. Feedback letters are sent out in the post as well as an annual ‘customer’ satisfaction survey. We reviewed some of the returned questionnaires. Comments made included, “I look forward to them visiting; they get me up and have lots of chat, which I love” and “Keep up the good work.”
The registered manager had a wealth of experience managing domiciliary care services and the staff told us they found her supportive and approachable. Office staff told us there was an open office culture and care workers regularly called in, which we observed happening. The service had the benefit of a large back office team who supported the daily operations with recruitment, payroll and finances. The registered manager had a clear vision for the service and wanted it to remain small in size and specialise in complex healthcare and nursing needs as well as supporting people at the end of their life.
The registered manager had introduced a staff recognition scheme and was rewarding care workers (voted for by their colleagues) with vouchers of their choice. The staff told us they felt like a valued member of the team. One staff member told us, “I love my job, it’s like a big happy family, everyone gets on well together.”