9 October 2019
During a routine inspection
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.