Jays Homecare Limited

Jays Homecare Limited is a domiciliary care service providing personal care to people in their own home. 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. The provider told us at the time of the inspection 23 people, aged 65 and over, received personal care.

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

People and relatives provided positive feedback about the service and said that it met their individual needs. They said they felt safe and secure around staff and were treated well. People said the service was timely and reliable.

Significant improvements had been made following the previous inspection in August 2019. Safe recruitment practices were now followed to help ensure staff were of suitable character to work with vulnerable people. There were enough staff deployed to ensure people received a reliable and safe service. Staff training, support and competency checks had been revamped and were now appropriate mechanisms for ensuring staff had the skills, knowledge and competence to care for people safely.

Improvements had been made to medicine management practices with clear records now in place demonstrating people received their medicines as prescribed. Risks to people’s heath and safety were assessed and well managed. People were protected from abuse and avoidable harm.

People and staff praised how the service was run and said communication with and from the management team was good. People and staff were regularly asked for their views on how the service operated. Improvements had been made to governance systems with an enhanced range of audits and checks undertaken and better oversight of performance and quality.

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 inadequate (published 18 November 2020) . 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.

This service has been in Special Measures since 18 November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced comprehensive inspection of this service in August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve care quality relating to Safe Care and Treatment, Staffing, Fit and Proper Persons Employed and Good Governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions ‘Is the service Safe?’ and ‘Is the Service Well-led?’ which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jays Homecare on our website at www.cqc.org.uk.

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.

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

People were not safe because medicines were not managed safely. Recruitment practices were not robust and did not ensure staff were suitable to work at Jays Homecare Limited. People were happy with the staffing arrangements and the same care workers usually visited. However, staffing was not always reliable because one person had three missed calls over a three week period. Staff said they would report concerns about people’s safety to the manager but did not know they could also report safeguarding concerns to the local authority. People’s safety was assessed and managed although we could not check everyone’s care records because only 10 people’s care files were available to review. Staff followed infection control procedures.

Staff received in-house training, but this did not equip them with the relevant knowledge. Staff often completed 10 training sessions in one day. Staff who started working at Jays Homecare Limited did not receive an appropriate induction. Most people managed their own healthcare or accessed services with support from their family and friends. People’s dietary needs and support at meal times were recorded; the service provided support with snacks and ready meals. 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.

Feedback from people who used the service and relatives was consistently positive. People spoke with genuine warmth when sharing their experience about individual care workers. They told us staff were kind and caring, and their dignity and independence was promoted.

People had care plans that usually outlined how staff should deliver care and the manager had visited people to check the care they received was appropriate. There was no information in people’s care records to show how the service has explored people’s preferences and choices in relation to end of life care. Systems were in place to deal with complaints although a concern raised by one person had not been recorded so the provider was unable to show how they had resolved the issue.

The provider's quality management systems were not effective and did not identify areas where the service had to improve. The manager and provider did not always have a clear overview of the service and incorrect information was shared during the inspection. The provider did not demonstrate they understood their responsibilities and accountability.

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 inadequate (published 15 February 2019) and there were multiple breaches of regulation. At this inspection improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jays Homecare Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to management of medicines, staff training and support, recruitment of workers and governance arrangements at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We recognised that the provider had failed to notify the Commission about some significant events. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

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.

The overall rating for this service is ‘Inadequate’ and the service remains 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 six 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.

The service was supporting 23 people, 17 lived in the Wakefield area and a further six in Leeds at the time of the inspection. The service had relocated offices in the summer of 2018 to Wakefield.

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 disabled adults. Not everyone using Jays Homecare receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in post at the time of the inspection. However, they only attended on the second day of the inspection as they are based in London. The office was run by two care co-ordinators who were the main contact for staff and people using the service. 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.

People were happy with the service they received but we found a number of concerns with safeguarding processes and systems. Staff did not recognise what might be abuse, and then concerns which were shared, were not always investigated or reported appropriately to the local authority.

There were a limited number of staff and the registered manager acknowledged if any were to go off sick they would struggle to provide a service. They did state they would not accept any more people until they had recruited more staff.

Risk management was in place but the assessments in place were basic and did not offer staff sufficient guidance. Accidents were not recorded properly and reviewed regularly.

We found significant issues with medication such as inaccurate records and contradictory information for staff, based on out of date guidance. The registered manager could not identify best practice guidance when asked. Staff were not suitably supervised and trained to carry out their roles and responsibilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

No one required specific nutritional support and people were confident that other health professionals would be called by staff if needed.

People spoke positively of care staff who they described as friendly and kind. They felt their wishes were respected and their dignity promoted. Care records reflected people’s needs and for the most part, their needs were met as they preferred based on feedback we received.

Complaints were not recorded properly and therefore the provider could not evidence appropriate action had been taken.

The registered manager was also the manager of a London branch and this meant they had little involvement with the Wakefield branch. This was evidenced by a lack of quality assurance systems in place and limited oversight. The service was being run by the two care co-ordinators who people and staff spoke highly of.

Due to the lack of registered manager and provider oversight we found significant issues with the service and found breaches of five regulations. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Jays Homecare Limited is based in the Crossgates area of Leeds and provides services in Leeds and Wakefield. The service is registered to provide the regulated activity Personal Care. The service provides assistance and support to people to help them maintain and improve their independence.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

We found people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines and audit the records of administration.

Overall, people we spoke with told us they were happy with the care they received from the service and they usually received support from consistent carers who knew their needs well and arrived on time. We found there were systems in place to protect people from the risk of harm and appropriate recruitment procedures were in place.

Staff were trained to meet people’s needs and received regular supervision of their work to ensure their practice was assessed.

People got the support they needed with their meals and healthcare.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and staff showed they understood how to ensure their practice was in line with the MCA.

The provider’s quality assurance systems were overall effective to ensure identified actions were addressed to improve the service. People had the opportunity to comment on the service and knew who to talk to if they wanted to discuss their care or raise a concern.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.