Archived: Caring at Home Limited

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

Improvements had been made since our last inspection including investment in developing policies and procedures and other management tools. Some of these tools still needed to be fully embedded to be effective in assessing and driving improvements. We made a recommendation about continuing to develop and embed good governance. There was a complaints procedure in place and any concerns were managed promptly.

Staff received training and support, including regular team meetings, to do their jobs well. People had developed caring relationships with the staff who supported them. People were appreciative and spoke fondly of staff. The provider had developed good working relationships with other health and social care professionals to support the needs of people using the service.

Risks to people’s health and wellbeing were assessed and plans were in place to monitor people and to assist them in a safe manner, staff knew how to support people safely, including the use of equipment to assist them to move. Staff understood how to protect people from harm and were confident any concerns would be reported and investigated by the management team. There were care plans in place to guide staff and these were regularly reviewed.

Where people received assistance to take medicines, records were kept so this was done safely. When people required assistance to eat or drink, the provider ensured this was planned to meet their preferences and their current assessed need. People had support when required, in order to liaise with healthcare professionals to ensure they remained well.

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.

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 22 August 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also held a meeting with them to discuss the actions they would take. 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 inspection took place between 4 July and the 11 July 2018 and was announced. At the last inspection we found that the provider required improvement in safe, responsive and well led questions and was rated as requires improvement overall. At this inspection we found that the improvements had not been made and they continued to require improvement.

Caring at Home 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 people with physical Disabilities. Not everyone using Caring at Home service received 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. At the time of our inspection there were nine people being supported under their regulated activity.

There was 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. The registered manager was also the provider and for ease we will refer to them as the registered manager throughout the report.

The registered manager had not complied with all of their responsibilities under their registration. They had minimal oversight of the service and did not routinely review it. They had delegated the majority of their responsibilities to a care manager but had not implemented governance to oversee their role and the service. When they had retained responsibility, they were not complying with regulation. They did not produce evidence that new staff were recruited in a safe way to protect vulnerable people in their own homes. They did not fully implement their complaints procedure including not responding to complaints. Notifications were not made to us in line with their registration so that we could review events that happened in the service. They did not return information to us as requested. Confidential information was not stored securely at the office location, and they had not displayed their previous inspection rating.

Where responsibilities to manage the service, and implement systems to review its quality, had been delegated to a care manager they were effective. The care manager had implemented audits and reviews of medicines management, risk management and care plans and these were used to make improvements. They had also embedded a computerised care planning system which assisted them to ensure that staff supported people as planned.

There were enough staff to meet people’s needs as planned. 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. People and their families chose how care was delivered and were included in writing care plans and reviewing them.

Staff received training and support to enable them to fulfil their role effectively. They understood their responsibilities to detect and report abuse. They had developed caring, respectful relationships with people and ensured that their dignity and privacy were upheld.

When the service was responsible people were supported to have enough to eat and drink and there were systems in place to monitor and review this. Some people were assisted to access leisure and social activities in line with their planned care. The staff had close relationships with other health and social care professionals to ensure people maintained good health.

Risk was assessed and actions were put in place to reduce it and their effectiveness was monitored and regularly reviewed. Lessons were learnt when things went wrong to reduce the likelihood of it happening again. There were systems in place to manage infection. Medicines were managed to reduce the risks associated with them and people received them when they needed them.

This is the second consecutive time the service has been rated Requires Improvement. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection on 18 April 2017. It was an announced inspection, which meant the provider knew we would be visiting. This was because we wanted to make sure the registered manager, or someone who could act on their behalf, would be available to talk with us.

This was the first inspection since the service was registered with CQC in December 2015.

A registered manager was 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.

People who used the service were at potential risk as recruitment procedures were not always thorough or effective. Care was not consistently person centred as people were not routinely consulted or involved in their individual care planning. Record keeping, including care plans, risk assessments and reviews, was poorly maintained. Although staff received appropriate training, support from the registered manager was inconsistent. Communication systems, including staff meetings were also unsatisfactory. Staff were confident and competent in their roles. They spoke positively and enthusiastically about the work they did and the people they cared for.

Systems in place to monitor the safety and quality of the service; and to gather the views and experiences of people and their relatives, were inconsistent and we have made a recommendation regarding this.

The provider had policies and procedures in place relating to medicines management. Staff understanding and competency regarding the management of medicines was subject to regular monitoring checks and medicines training was updated appropriately.

Where people lacked the mental capacity to make decisions the service was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

The service was flexible and responded positively to people’s changing needs and any issues or concerns raised. People and their relatives spoke positively about the service provided and were confident that any concerns they might have would be listened to, taken seriously and acted upon.