IRC Care Services Limited

IRC Care Services Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, people living with dementia and younger disabled adults. At the time of our inspection IRC Care Services Limited were supporting 21 people.

Not everyone who uses the service may receive 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

People were positive about the support and care they received from the staff at IRC Care Services Limited.

Peoples choices and preferences around their care and support were discussed with them and recorded in their care plans. However, we have made a recommendation about increasing the detail in end of life care plans so that staff would have a better understanding of the impact of people’s religious or faith-based needs.

People had care plans in place. They gave staff enough information to provide care and support that met people’s preferences. People were positive that staff understood their needs and gave care and support in a way they wanted.

People told us they felt safe with the staff, and staff were aware of their responsibilities in keeping people safe from harm. There were enough staff to meet people’s needs. People told us that staff arrived on time and stayed the allocated time. Where people were supported with their medicines, they told us this was done in a safe way, and they were given them when they needed them.

Staff received training and supervision to ensure they kept up to date on best practice and had the skills to meet people’s individual needs. People were positive about staff supporting them to have enough to eat and drink, as well as making sure they could access healthcare agencies when they became unwell.

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 were supported by kind and caring staff, and we saw that where ever possible staff were matched with people so they had similar interests. People gave positive feedback about how well the care staff interacted with them involving them in decisions around their care and treated them with dignity and respect.

Where complaints had been received these had been used to make improvements to the service.

The provider completed various audits to assist them in monitoring and helping them to identify how to improve people's experiences. People told us they felt the service was well managed.

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 27 October 2018). 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults with disabilities. At the time of our inspection IRC Care were supporting 46 people.

There was a registered manager in post who supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission 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.

At our inspection on 23 February 2017 we found that quality assurance checks were not being regularly completed and that records management was inconsistent. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of well-led to at least good. At this inspection we found there had not been sufficient improvements in these areas and the service continued to breach this regulation. In addition, we identified a further two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Quality assurance processes were not always effective in ensuring that any shortfalls in the service were identified and acted upon. No audits were completed which meant areas which were in need of improvement such as staff spot checks and training had not been identified. Spot checks on staff performance were not completed regularly in order to monitor staff competence. Staff did not receive induction and training in line with the providers policy and the supervision of staff was not completed at the stated intervals.

Not all staff we spoke to were knowledgeable about safeguarding processes. Some staff were unable to tell us the different types of potential abuse people may experience and were not aware of how to report concerns to outside agencies.

Although risks to people’s safety were managed well, staff did not always receive guidance on the action to take when supporting people with specific health conditions. Care records did not always contain personalised information about people and their backgrounds. There was little information within people’s care records regarding the care they wished for at the end of their lives. We have made recommendations regarding these areas of people’s care.

Sufficient staff were employed to meet people’s care calls. People and their relatives told us that on the whole staff arrived on time and stayed for the planned duration of the call. Safe recruitment practices were followed to ensure staff employed by the provider were suitable to work at the service. Staff were supported by an on-call service which provided assistance when working out of hours. The provider had processes to follow in the event of unforeseen circumstances occurring such as severe weather or IT failure.

Accidents and incidents were recorded, reviewed and action taken to minimise the risk of them happening again. Safe infection control procedures were followed and staff had access to personal protective equipment. Environmental risk assessments were completed which considered risks to both staff and people receiving care. Where people required support with their medicines this was provided safely and records were clear. Where required people were supported to access healthcare professionals and guidance provided was followed.

People’s needs were assessed prior to people receiving a service to ensure they could be met. Care plans contained details of the care people required and staff recorded this had been completed at the end of each care call. Where people’s needs changed, responsive action was taken to provide them with the support and equipment required to provide their care. People’s legal rights were protected as the service followed the principles of the Mental Capacity Act 2005. Staff consulted people about their care and ensured they gained people’s permission prior to supporting them. Where people required support with meal preparation choices were offered and staff were aware of any specific dietary needs.

People were supported by caring staff who knew them well. Staff visited the same people regularly and were familiar with their needs. People were offered choices and felt in control of decisions regarding their care. Staff ensured that people’s independence was promoted. People were treated with dignity and their privacy was respected. Staff understood the importance of respecting people’s cultural and religious needs.

People, relatives and staff told us the registered manager was approachable and took action when required. Feedback from people and their relatives was sought on an annual basis and action taken to minimise any concerns raised. Staff told us they felt able to make suggestions and felt valued. Regular staff meetings were planned and staff were encouraged to work together as part of a team. The provider had a complaints policy in place and records showed that any concerns had been investigated and acted upon. Records were securely stored and were in the process of being transferred onto an electronic system.

We have identified 3 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People who receive a service in their own homes include those living with physical support needs. The agency also provides services to people living with dementia and those who may have mental health needs. At the time of our inspection 40 people received care and support in accordance with the regulated activity of personal care.

The inspection took place on 23 February 2017. The provider was given forty eight hours’ notice of the inspection.

There was a not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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. A new manager had been in post for two weeks, and had begun the registration process with CQC.

The lack of a registered manager had an impact on the service as the systems in place to monitor the quality of care and support that people received were not as well managed as they could be. Staff had not had the opportunity to have supervision with their manager, so their practice when giving care and medicines had not been regularly assessed. The records relating to the care and treatment of people and the overall management of the service were had not been regularly reviewed to ensure they were of a good standard. We have identified one breach in the regulations. You can see what action we have asked the provider to take at the back of this report.

Care plans were based around tasks staff needed to complete, rather than people’s personal preferences. They gave staff brief guidance on what tasks they needed to complete, and therefore were not person centred.

Staff had a positive and caring attitude about their jobs. People told us that they were happy with the care and support they received. A person said, “They (staff) are loving and caring people, and they know what they are doing.” All the staff we spoke with were happy in their work and proud of the job they do.

People received a safe service from IRC Care Services Ltd. There were sufficient numbers of staff who were appropriately trained to meet the needs of the people. Staff worked in geographic areas to minimise the impact of travel times between each call.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding board or the police.

Staff recruitment procedures were safe. The provider had undertaken appropriate safety checks to ensure that only suitable staff were employed to support people in their own home. Staff said they felt supported to undertake their roles. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. The majority of people were prompted by staff to take their medicines, but where staff gave people their medicine this was done in a safe way.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed.

People were supported to have enough to eat and drink. They received support from staff where a need had been identified. People’s dietary support needs were recorded and met by the staff.

People were supported to maintain good health. When people’s health deteriorated staff responded quickly and made sure they contacted the appropriate professionals so people received effective treatment.

People told us the staff were kind and caring and treated people with dignity and respect. People said they received the care and support as detailed in their care plans.

People knew how to make a complaint. When complaints had been received these had been dealt with quickly and to the satisfaction of the person who made the complaint. Staff knew how to respond to a complaint should one be received.

People received a good standard of care and support by a caring service. A person said, “My care worker is friendly and I get on well with her.”