Generations Care Ltd

Generations Care Ltd is a domiciliary care agency which provides personal care to people in their own homes. The service provides support to older people and younger adults with a range of needs. This includes people with physical disabilities. At the time of our inspection the service was providing the regulated activity personal care to 115 people. CQC only inspects the service being received by people provided with 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

Quality monitoring and checks had not always been completed to provide effective managerial oversight of the service. The provider acknowledged that improvements were needed in their governance systems and was in the process of implementing a new quality assurance system at the time of our inspection.

The provider had a contingency plan in place, to minimise any risks to the service running safely in the event of, for example adverse weather conditions. Staff felt supported by the management team.

Risks associated with people’s care were assessed and staff understood their responsibilities to keep people safe. However, some risk assessments lacked detailed guidance to inform staff how to support people safely. Medicines were administered by staff trained in medicine management, although some records needed improvement to ensure that people were safe. Staff were recruited safely.

People and relatives were involved in their care plans to ensure they reflected people’s preferences, religious and cultural beliefs and values. People knew how to make a complaint and feedback on the service was encouraged. People spoke positively about the service and were confident that any concerns would be responded to promptly and resolved.

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 and update

The last rating for this service was requires improvement (published 30 August 2022) and there were breaches of regulation. The provider had received a warning notice following the last inspection and they had to be compliant with this. The provider was also required to send us an action plan telling us how they would improve and by when. At this inspection not enough improvement had been made and the provider was still in breach of regulation 17 (Good Governance).

The overall rating for the service has remained requires improvement. This service has been requires improvement for the last 3 consecutive inspections.

Why we inspected

We undertook this focused inspection to check they 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, responsive and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. 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 Generations Care Ltd on our website at www.cqc.org.uk.

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 a breach in relation to the governance of the service. We found the provider failed to meet all of the warning notice we issued at the last inspection.

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.

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.

Generations Care Ltd is a domiciliary care agency which provides personal care to people in their own homes. The service provides support to older people and younger adults with a range of needs. This includes people with physical disabilities. At the time of our inspection the service was providing the regulated activity personal care to 104 people. CQC only inspects the service being received by people provided with 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 did not always feel their preferences were met, in relation to call times and the gender of staff, supporting them. People knew how to make a complaint. However, people did not always feel confident their complaint would be resolved.

Quality assurance checks were not effective and robust enough to provide effective oversight of the service. As, they had failed to identify the issues we found. The provider acknowledged that improvements were needed in their governance systems and told us that they would take action to address this.

Risks associated with people’s care were not consistently assessed and well managed. Medicines were not always managed safely. People felt safe with the staff who supported them. Staff were recruited safely and felt supported by the management team.

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

The last rating for this service was requires improvement (published 13 March 2020).

Why we inspected

We received concerns in relation to the safety of people using the service. As a result, we undertook a focused inspection to review the key questions safe, responsive and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive 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 Generations Care Ltd 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 and will take further action if needed.

We identified breaches in relation to people’s safety and the governance of the service.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Generations Care Ltd is a domiciliary care service which provides personal care to people in their own homes. At the time of our inspection the service provided support to 100 people and employed approximately 50 care staff.

People’s care records were reviewed every two months. Systems for reviewing people’s care were not always robust and did not immediately identify issues. Staff told us they were happy working at the service and received the support and guidance they needed to support people. The registered manager was supported by a management team that understood the importance of investigating and responding to concerns. The registered manager was working with other stakeholders to improve people’s experience of care.

People did not always feel their preferences were met. People’s preferred call times were not always met and there were inconsistencies in the staff team supporting them. People understood they could complain if they needed to and understood the process for doing so. However, people did not always feel confident their complaint would be resolved.

People felt safe around staff who had received training to keep them safe. Risks were detailed and reviewed regularly. Staff understood the risks people lived with. Background checks were in place to recruit staff safely. People felt they received the support they needed. The registered manager reviewed practices to improve people’s experience of care. The registered manager was in the process of implementing a call monitoring system to track staff attendance at calls.

People’s needs were assessed prior to the care commencing so that the registered manager could fully plan for people’s needs. Staff training and supervision was monitored. Staff worked with other healthcare professionals to meet people’s needs. People were offered choices of food and drink.

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 liked the staff supporting them. People’s human rights were protected and promoted. People told us they were treated with dignity and respect. Staff also supported people to remain as independent as possible.

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 25 August 2017).

Why we inspected

This was an inspection that was brought forward as a result of a complaint made to the CQC).

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 3 September 2015 the service was rated Good. At this inspection we found the service remained Good.

The office visit took place on 9 August 2017 and was announced. We told the provider before the visit we were coming so they could arrange to be there and for staff to be available to talk with us about the service.

A requirement of the provider’s registration is that they have a registered manager. There was a registered manager in post at the time of our inspection. 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.

People did not always receive their care calls at the agreed time. The registered manager was taking action to address this. People and relatives spoke positively about the quality of care and support they received. There was enough suitably trained care workers to allocate all the care calls people required and to meet their needs safely.

Care plans were personalised and provided care workers with the information needed to ensure care and support was provided in the way people preferred to meet their needs. Systems were in place to manage people’s medicines and staff had received training to do this.

People felt safe with their care workers and continued to receive care which protected them from avoidable harm and abuse. Risks to people’s safety were identified and management plans were in place to help reduce these risks. Recruitment checks were completed on potential new staff to ensure they were suitable to support people in their own homes.

The registered manager understood the relevant requirements of the Mental Capacity Act 2005. Care workers sought people’s permission before care was provided and encouraged people’s independence where possible.

Care workers received training and support to enable them to provide effective care to people. The management team regularly checked care workers practice to make sure they continued to meet people’s needs whilst working within the provider’s policies and procedures.

People received support from care workers who they said were caring and friendly and who respected their privacy and dignity. People and their relatives were involved in making decisions about their care and had formed good relationships with the care workers who supported them. When needed people were supported to maintain their nutrition and health care needs.

The management team regularly monitored the quality of service provided and invited people and relatives to share their views about the service. The provider used feedback to enable the service to improve.