Invicta 24 Plus

Invicta 24 Plus is a domiciliary care agency providing personal care to 74 people at the time of the inspection. In some cases, the service provided live-in care staff.

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

The service people received was not always safe, because some risk assessments lacked the personalised detail needed to fully inform staff how to care safely for them. Record keeping was not always sufficiently robust to demonstrate people received their medicines as prescribed. The provider was not able to demonstrate they had taken adequate action to address risks arising from some staff being unable to follow current guidance about the use of PPE during the COVID-19 pandemic. Although systems to assess the quality of the service did in most cases identify shortfalls in quality or safety, they were not always effective in making improvements to make sure people received the best and safest care the service could provide.

However, although improvements were needed to safety and governance systems, we were assured people were not at risk of immediate harm. This was because staff knew people well and received training in how to care for people safely, and more serious risks to people were appropriately assessed and documented.

There were systems to ensure there were enough staff, who were able to attend visits on time and spend enough time with people. Staff recruitment and safeguarding processes were set up to protect people from the risks of abuse, neglect or inappropriate care.

The service had recently recruited a new manager who was in the process of becoming registered with CQC. The new manager had put in place a service improvement plan and there was evidence of some improvements made as a result. There were plans to improve the quality of risk assessments, medicines audits, record keeping and recruitment which were the same areas we found needed improvement.

Staff treated people with respect and dignity, understood their diverse needs and respected their preferences. People received care that was compassionate and empathetic from staff who spent time getting to know them well.

The service had an open and inclusive culture. People, relatives and staff were consulted about their care or employment with the service and the provider listened to and acted on their feedback. People told us they felt comfortable approaching managers with any concerns.

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 requires improvement (published 20 August 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to staff treating people with respect, moving and handling practices and management of infection risks, particularly in relation to COVID-19. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We undertook a targeted inspection within the caring key question to check on the specific concern we had about staff treating people with respect. CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe 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 Invicta 24 Plus on our website at www.cqc.org.uk.

Enforcement

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.

We have identified two breaches in relation to safe care and treatment and good governance. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Invicta 24 Plus is a domiciliary care agency providing personal and nursing care to 83 people at the time of the inspection. 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 did not always find sufficient evidence that people were supported to have maximum choice and control of their lives and that staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not fully support this practice. This was because there were not robust procedures to ensure there was evidence that people always consented to the care they received.

However, the feedback we received from people and their relatives was positive. Comments included, “The service is very good – fantastic,” “Some carers go above and beyond expectations” and, “My carer is warm and caring. [Staff member] is a lovely lady, brilliant. I would be lost without her.”

The provider had made improvements to the staff recruitment process since our last inspection. This helped to ensure only suitable staff were recruited to care for people. There were systems to ensure enough staff were deployed at the right times to provide the care people needed.

People had individual risk assessments, but they did not always contain enough detail for staff to know how to manage risks safely. The registered manager told us they would review these. Staff knew how to report safeguarding concerns and how to keep people safe from the risk of infection.

Staff were competent to administer medicines and people received their regular medicines as prescribed. There was not always enough detail about when to offer people medicines prescribed only to be taken when required. We have made a recommendation about the management of this type of medicine.

People received care from staff who had the knowledge, skills and support they needed to perform their roles effectively. Staff had access to information about current best practice and shared relevant information about people’s care with other organisations when needed. They made sure people’s healthcare needs were met and that people had enough to eat and drink.

Staff were able to build positive relationships with people and get to know them well. People felt respected and valued by staff and were able to make choices about their care on a daily basis. The service promoted independence, dignity and respect for people’s diverse needs.

Care was planned and delivered in a person-centred way that took into account people’s individual needs and preferences. This included support to meet social needs. The provider sought appropriate support and guidance to enable them to provide good quality end of life care. Staff used appropriate techniques to support people with a reduced ability to communicate verbally.

The provider had a policy and procedure for dealing with complaints and people told us the registered manager responded appropriately to complaints and concerns. However, the provider did not always keep clear records of the action they took in response to complaints.

The service had a person-centred culture that took equality and diversity into account. Good communication and teamwork made it easier for staff to provide good quality care. The provider also worked well with other agencies to share information and provide joined up care. People and staff felt the management were supportive and approachable.

The provider had systems to ensure care records were complete and accurate and that staff were providing good care. However, these were not always effective in auditing care plans because some contained out of date or contradictory information that could be misinterpreted.

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 11 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Invicta 24 Plus is a domiciliary care agency located in the London borough of Croydon. It provides personal and practical care to a range of people living in their own homes mainly in the Bromley area. Those receiving care had various needs including people living with dementia. Forty people were using the service at the time of our inspection. At the previous inspection in August 2015 the service was meeting all the regulations we inspected it against. At this inspection we found no breach in regulations but we identified some shortfalls in recruitment procedures.

There was a registered manager in post at the time of our inspection. 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 were positive about the care they received, and told of a reliable service, they received their home visit calls at the time agreed. People felt safe. The agency had procedures in place to identify and manage appropriately risks associated with people’s care needs within their home environment. The service developed care plans and arranged for suitably skilled care workers to deliver care and support in response to these. Care staff understood the needs of the people they were supporting. They knew how to recognise the signs of abuse and how to report any concerns.

Recruitment processes had some shortfalls and required improvements when the service was taking up staff references. Induction training and support was provided to new staff. The agency had sufficient numbers of suitably skilled staff to care for people. Staff understood their roles and responsibilities and the codes of practice that needed to be observed. Management made sure staff were suitably trained and competent, overseeing staff practice that ensured staff followed this guidance.

The agency had procedures in place to ensure that people were supported with their medicines safely which staff followed. People were protected against the risk and spread of infection as staff were trained. They used protective clothing supplied and followed infection control measures.

Staff asked for people’s consent before delivering care. People and their relatives where appropriate were involved in planning their care, people were in control of the care they received. Staff understood the provisions of the Mental Capacity Act 2005 and how it applied to people they cared for.

People told us staff treated them with respect and kindness. People’s healthcare needs were met; care staff liaised with relevant health professionals to help promote their health and wellbeing. Staff ensured people were encouraged to eat a balanced diet and summoned appropriate intervention if there were any concerns. Regular checks were carried out to ensure staff practice promoted people’s health and well-being.

The service had a manager who inspired and led staff to deliver a service of high quality. The provider had systems in place to help ensure the safety and quality of the service provided and monitor the service.