Julee Care Limited

Julee Care Limited is a domiciliary care agency providing care and support to older people in their own home. At the time of our inspection there were 26 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. Where they do, we also consider any wider social care provided.

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

Risks relating to people’s care and support were not always assessed and care records lacked key information about how to manage those risks.

Staff were not always deployed to meet people's needs in a timely manner and at the time agreed.

Systems to administer and record medicines given to people were not robust and not understood by the registered manager or staff.

Care staff had access to training, however this did not cover all the areas required to ensure they had the right skills and knowledge to support people who used the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Quality assurance systems in place were not being fully effective and did not highlight the concerns we found during this inspection, or made improvements following previous recommendations. Notifications of significant events were not made to CQC as required.

People told us they felt safe with the care provided. People told us staff ensured people had adequate food and drink available and would support them to access healthcare professionals.

Staff were clear on what actions they needed to take in relation to infection prevention and control (IPC), including the wearing of personal protective equipment (PPE) and regular hand washing.

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 20 November 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 requires improvement 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Julee Care Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, obtaining consent and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 follow up in a couple of months and request evidence of actions taken. 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.

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

People felt safe. One person said, “I do feel safe and I am very happy with everything.” Risks associated with care and the environment were recorded and monitored. There were enough staff to meet people's needs in a consistent and flexible way. Staff protected people from avoidable harm, were knowledgeable about safeguarding and felt able to raise concerns. Systems were in place to recruit staff safely. Staff did not administer people’s medicines but prompted them to take these when needed.

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. Consent to care was sought and staff understood people's rights to make their own decisions. Staff received training in key areas, and plans were in place to source further training for staff. Staff received support to enable them to carry out their roles effectively. New staff received an induction and shadowed the management team as part of this. Systems were in place to ensure information to support people was shared and discussed appropriately with health professionals, where necessary.

People told us staff were kind and caring. They had built meaningful relationships with staff and felt they mattered and were listened to. Staff were aware of the importance of promoting people’s dignity and maintaining their privacy.

People's needs were assessed before they began to use the service and care plans were developed from this information. Care plans overall, contained information for staff to support people according to their needs. Some care plans needed strengthening to ensure they contained more detail about people's care. A system was in place for responding to people's concerns and complaints. People's relatives told us they felt confident to raise any concerns. No person required end of life care at the time of inspection.

People and staff felt the service was well led. Some areas of improvement continued to be required, particularly in relation to recording and training. However, these did not directly impact on the care people received. Compliments and surveys showed people were happy with the service they received. Quality assurance systems identified where the service needed to improve. The registered manager was responsive to any issues raised during the inspection and demonstrated a passion and enthusiasm for driving improvements where identified.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 24 October 2018) and there were multiple breaches of regulations. 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.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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 was the first inspection since the service registered with CQC on 4 December 2015. The service had been dormant during this period and commenced providing a regulated activity in October 2017. At the time of our inspection five people were being supported with a regulated activity of personal care.

Following the inspection, we wrote to the provider to ask the provider to complete an action plan to show what they would do and by when to improve the key questions to at least achieve a rating of good.

The service had a registered manager. '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.'

We found that people were not always kept safe. The provider did not have adequate systems and processes in place to ensure risks were effectively assessed and measures put in place to mitigate them. The recruitment process was not robust or consistent.

The provider was unable to demonstrate that staff had received appropriate training and had the skills and abilities to ensure people received effective care. Support arrangements were ineffective.

The service was not consistently caring. People did not always receive care that was kind, compassionate and personalised.

The service was not always responsive to peoples changing needs. There had been no complaints recorded so we could not assess the effectiveness of the policy as it was not current. There was no evidence of feedback from people or that their views were taken into account as a means of improving the service.

The service was not consistently well led. There was a lack of management oversight and the registered manager had not established or embedded systems and processes to manage the overall quality and safety of the service.

We found the provider was not meeting regulations 12,13,17, 18 and 19. You can see what action we told the provider to take at the back of the full version of the report.' Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.