Background to this inspection
Updated
20 November 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was completed by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The provider was also the manager registered with the Care Quality Commission. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced. We gave a short period notice of the inspection because it is a small service and we needed to be sure that the provider would be in the office to support the inspection.
Inspection activity started on 9 October and ended on 10 October 2019. We visited the office location on 9 October 2019.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed the provider’s inspection history and basic information the provider sent us about people who used the service. We used all of this information to plan our inspection.
During the inspection
We spoke with the provider. We reviewed a range of records. This included one person’s care records and medication records. We looked training records for the provider and staff member. We also looked at a variety of records relating to the management of the service, including policies and procedures.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training and induction processes and insurance certificates. We spoke with one person who uses the service.
Updated
20 November 2019
About the service
Vera Care provide personal care to one person in their own home. The Care Quality Commission (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 told us they received the care and support they wanted in the way they preferred from the provider. The provider worked alone for most of the time and was supported on rare occasions by a member of care staff.
We found no evidence that people had been harmed however the provider was not operating systems and processes to ensure that people always received safe, effective, well led care which reflected their needs and preferences. This was important as the provider intended to employ more staff and expand the business.
The provider and staff member did not have the skills they needed to ensure people’s care was safe. For example, they had not completed training in medicines management, despite supporting people with their medicines. The provider prepared people’s meals and drinks but had not completed in depth food hygiene or infection control training.
Risks to people, including oral health care, had not been assessed. People told us they had planned their care with the provider and always received their care in the way they preferred. However, guidance about how to identify some risks had not been recorded. Assessments of people’s needs had not been completed to identify any changes in their needs.
Risks relating to people’s homes had not been fully assessed. Support to keep people safe in an emergency had not been planned. Systems were not in operation to learn from accidents and incidents and prevent them for happening again. People had not been given the opportunity to share their end of life wishes and preferences.
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; however, the policies and systems in the service did not support this practice. There was a risk that people would not always receive support to make decisions in ways which suited them best. Information about the service was not available in a variety of formats to ensure people always had the information they needed.
People told us they felt safe while the provider was in their home. The provider had not completed robust safeguarding training and there was a risk they may not identify when people were at risk of abuse.
A system was not in operation to ensure people received their care if the provider was not able to provide it at short notice. No new staff had been recruited since the last inspection.
The provider did not have systems in operation to invite feedback about the service from people, their relatives, staff and professionals. Other systems were not in place to check and evaluate the service and the provider was not aware of the shortfalls we found. The provider did not work with others to develop their skills or the service. Plans were not in place to continually improve the service, despite the providers plan to expand.
The provider did not fully understand their responsibilities to under the Health and Social Care Act 2008. We had not been informed about changes to the provider’s contact details.
People told us the provider prepared their meals and drinks in the ways they preferred. The provider identified changes in people’s health and supported them to contact health care professionals and follow their advice.
People said the provider was kind and caring and they got on well with them. They told us they were listened to and the provider delivered their care and support in the way they wanted. These were underpinned by the provider’s vision and values. People had shared their lifestyle choices with the provider and these were respected. People were supported to maintain their independence.
Any complaints or concerns people had raised had been addressed. The provider had a process in place to support this.
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 17 October 2018). The service remains requires improvement. The service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to staff skills and training, risk management, medicines management, planning end of life care, assessing people’s needs, accessible communication, obtaining consent to care, understanding people’s experiences of the service and the quality of the service, at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.