Revelation Social Care Ltd

Updated 26 May 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 1 inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 5 April 2023 and ended on 24 April 2023. We visited the location’s office on 5 and 12 April 2023.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also received feedback from the local authority commissioning team. We used all this information to plan our inspection.

During the inspection

We spoke with 3 people who use the service, 4 relatives and 8 members of staff. This included the registered manager, administration staff and care staff. The registered manager is also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included care records, medication management, staff recruitment and training. Additional evidence, sent to us electronically, was reviewed remotely. These included, staffing arrangements, policies, and procedures as well as information to evidence management and oversight of the service.

Updated 26 May 2023

About the service

Revelation Social Care is a domiciliary care agency. It provides the regulated activity personal care to people living in their own houses and flats in the community. At the time of our inspection there were 32 people using the service. 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

Robust systems were not in place providing clear management and oversight of the service. The office area was disorganised and did not provide an effective working environment. Both electronic and paper records were inaccurate and incomplete.

The registered manager recognised the service was not equipped to support some of the people in their care. This was being addressed with the local authority. The registered manager also liaised with the local authority safeguarding team where issues and concerns had been raised.

Robust recruitment practices were not followed. Systems to support and develop staff did not ensure they had the knowledge and skills needed to support people safely and effectively. Some staff had worked excessive hours with inadequate breaks. This potentially placed the health and well-being of the service user and staff at risk.

People’s medicines were not managed and administered as prescribed. Staff training and assessments of competency had not been effective to ensure practice was safe. Information showed people had access to healthcare support, where necessary. We were told support to appointments was provided if needed.

Feedback from people and family members was very positive about the support provided and felt the registered manager was responsive. We were told staff enabled people to make their own decisions and offered choice when carrying out tasks. However, we found the service was not working within principles of the Mental Capacity Act. (MCA). Records did not clearly evidence capacity had been assessed and decisions were made in the people’s best interests.

People felt they were cared for in a safe way. However, staff felt, and records showed further development was needed, so staff were clearly guided in the support people needed to keep them safe. During the inspection, specific areas of training had been arranged for staff. This learning needed embedding and included within the individual support plans.

Suitable arrangements were in place to minimise the spread of infection. Records showed and staff confirmed training was provided in infection control. Staff told us personal protective equipment (PPE) was readily available and worn when carrying out care tasks. This was confirmed by people we spoke with.

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 22 January 2019).

Why we inspected

We received concerns in relation to the management and conduct of the service, safeguarding, staff training and development and safe care and treatment, particularly in relation to risk management. As a result, we undertook a focused inspection to review the key questions of safe, effective, 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 changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, 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 Revelation Social Care on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to consent, safe care and treatment, staff recruitment and training and good governance at this inspection. A warning notice has been issued in relation governance systems to ensure effective management and oversight of the service.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.