Options Health Care Services

Options Health Care Services is a domiciliary care agency providing care and support to older people in their own home. At the time of our inspection there were 6 people using the service.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. Where they do, we also consider any wider social care provided.

Options Health Care Services changed its registered office address on 09 January 2022. It was previously registered at Unit 14A Meadway Court, Rutherford Close Stevenage SG1 2EF. The address changed to 241 Kings Court, London Road, Stevenage, Hertfordshire, SG1 2NG. The provider had not notified us of this, despite prompting at our DMA on 29 September 2022. It was only changed as a result of this inspection.

People’s experience of using this service and what we found

Risks relating to people’s care and support were not always assessed and care records lacked key information about how to manage those risks. We have made a recommendation about documenting people’s known health needs.

Staff were not always deployed to meet people's needs in a timely manner and at the time agreed.

Staff were clear on what actions they needed to take in relation to infection prevention and control (IPC), including the wearing of personal protective equipment (PPE) and regular hand washing. However, we were told that staff did not always wear masks which people preferred.

Quality assurance systems in place were not being fully effective and did not highlight the concerns we found during this inspection, or made improvements following previous recommendations. Notifications of significant events were made to CQC as required.

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 told us they felt safe with the care provided. People received their medicines as the prescriber intended.

People were positive about the care they received and the management of the service.

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 26 July 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but the provider remained in breach of one regulation.

This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This indicated concerns in relation to staffing, risk management, consent and overall management of the service.

As a result, we undertook a focused inspection to review the key questions of safe 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 based on the findings of this inspection.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Options Health Care Services on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to good governance at this inspection.

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 follow up in a couple of months and request evidence of actions taken. 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.

People’s experience of using this service and what we found

A safeguarding incident that was being investigated by the local authority had not been reported to CQC as required.

The provider had been denied access to their office by the landlord due to a dispute. The provider told us they had not had access to the office since 4 March 2019.

Monitoring systems were not adequate to ensure people had received their calls and that people were safe.

The provider failed to demonstrate that adequate quality assurance processes were in place.

At the last inspection we had identified an issue with recruitment processes. At this inspection we were unable to review recruitment processes to ensure the required improvements had been made.

People and relatives told us they were happy with the care. People confirmed that they received their calls on time and if staff were running late they would be contacted and advised of the lateness. However, one person told us about a missed call.

People told us that they had contact details for the staff and the provider. They confirmed that they knew who to contact in an emergency. This was not everyone’s point of view one person told us that they were unable to contact the office and they had now resorted to sending emails, but this was not working effectively.

Staff confirmed they had regular training and supervisions. They felt supported by the provider.

Staff and relatives all commented that staff were kind and caring. People had developed caring relationships. People felt their privacy and dignity were promoted and staff supported their independence.

People confirmed they were supported with their nutritional and fluid requirements.

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 provider confirmed that all people they were providing care and support had full capacity.

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 Good (the last report was published 4 May 2017).

Why we inspected

The inspection was prompted in part due to concerns raised. The local authority was investigating these concerns under their safeguarding procedures. Concerns included late care visits, missed care visits and not effectively and safely implementing the advice from the physiotherapist for moving and handing. The local authority visited the providers premises to carry out some checks and found that the provider had been locked out of their offices. The local authority withdrew their contracts from the service.

The provider under the regulations had a duty to inform CQC of the safeguarding but failed to notify us. A decision was made for us to inspect and examine those risks. The local authority confirmed the safeguarding concerns was substantiated. We 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.

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 to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The provider for Options Health Care Services was also the registered manager for this location.

There was a manager in post who had registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

Recruitment processes were safe to ensure that staff employed to deliver care and support for people were of a good character and suitable to meet people`s needs safely. There were sufficient numbers of staff available to meet people’s individual needs.

Potential risks to people’s health and well-being were identified by staff and they knew how to manage these effectively and protect people from harm. Risk assessments were completed to keep people safe.

People told us that they were involved in their care and staff always asked for their consent when providing care.

People and their relatives told us that their family members were kept safe and cared for when they were being supported by the service. Staff had received training in how to safeguard people from potential abuse and knew how to identify the risks associated with abuse.

Staff were trained in safe administration of medicine; however people told us that they had not required staffs support to take their medicines.

People and their relatives were very complimentary about the abilities and experience of the staff that provided care and support. Staff received training and regular updates to ensure they were up to date with their knowledge and best practice guidance.

Staff supported people to stay safe in their homes, and people were supported to maintain their health and well- being. Staff developed appropriate positive and caring relationships with the people they supported and their families, and feedback from people was consistently positive about the service they received.

People and their relatives where appropriate were involved in the initial planning of the care and support people received. People's personal information was stored securely and confidentiality was maintained.

People told us they felt the staff provided care and support that was delivered in a way that promoted their dignity and respected their privacy. Staff were knowledgeable about people`s preferred routines.

People told us that they felt that staff listened to them and responded to them in a positive way. People and their relatives knew how to raise concerns and they were confident that the registered manager would take appropriate action to address any concerns they may have had in a timely way.

People were asked to provide feedback about the service they received regularly and we saw these were positive. People and their relatives were positive about the staff and the management of the service. The registered manager regularly audited the service any improvements needed were actioned.

Options Health Care Services provides personal care to people living in their own homes. At the time of our inspection, five people were receiving support from the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. In this instance the registered manager was also the provider.

Where people had been supported with medication this had not always been documented accurately and the provider was unable to demonstrate that audits had been completed.

There were inadequate systems in place to monitor the quality of the service and address any shortfalls.

People received care and support that met their needs. Staff respected people’s choices, preferences and promoted their dignity.

People were supported by sufficient numbers of staff who had been recruited safely and had the appropriate skills for their role. Staff received regular support and supervision and had the opportunity to attend meetings.

Staff knew how to identify abuse and risks to people and respond appropriately. People’s medicines were managed safely. The management team were available for guidance and support should it be needed. Everyone we spoke with was positive about the management of the service and the ethos of the service. Staff knew what was expected of them and people told us that they were all very kind and caring.

People’s feedback was sought and this was responded to appropriately.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.