We carried out a review of the data available to us about Quality Home Care on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Quality Home Care, you can give feedback on this service.
Quality Home Care is a domiciliary care service providing personal care to 27 younger adults and older people in their own houses and flats in the community. Not everyone who used the service received personal care. The Care Quality Commission (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 protected from harm and abuse by dedicated caring staff. Risk assessments were in place to mitigate risks and these were reviewed regularly. There was enough staff to support people and meet their needs. Recruitment processes had been improved but further improvements were required to ensure safe recruitment decisions were consistently recorded and all checks fully completed. We have made a recommendation about this.
Staff had an induction into the service and received training, supervision and appraisals to enable them to deliver effective care. Staff had not always completed Mental Capacity Act 2005 (MCA) training, the registered manager had acted to address this.
The provider completed assessments before providing a service to identify people’s needs. 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.
Relatives told us they were very happy with the care their loved ones received. Staff knew people well, including their past history and family and friends important to them, which meant they could enjoy meaningful conversations.
People had personalised care plans that promoted independence. Staff identified and met people's information and communication needs. People and relatives knew how to make a complaint and felt confident they would be listened to.
Systems had been developed to review the quality of care provision. The registered manager understood the importance of gaining people's views about the quality of the service.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 8 January 2019) and there were two breaches of regulation. 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.
At the last inspection in August 2017, the service was rated Requires Improvement and the provider was in breach of three regulations. These related to unsafe recruitment practices, staff training and support and governance; these affected the key questions of Safe, Effective and Well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least good. We checked to see that the action plan had been completed and found progress had been made in some areas, including staff recruitment. However, there continued to be concerns with staff training and a lack of governance systems. This is the second consecutive time the service has been rated requires improvement.
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 and younger adults.
Not everyone using Quality Home Care receives a 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, five people were receiving a 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.
Systems to recruit staff safely had been improved and relevant pre-employment checks were in place. We found the registered manager and provider were now compliant in this area of the regulation. However, staff training and governance, areas they were required to improve during the last inspection, had not been sufficiently improved and they continued to be in breach of the regulations in these areas.
Some small improvements had been made to how the service was run, such as ensuring staff received supervision and an appraisal. Although some training for staff was now planned, assurances that staff had the necessary skills and abilities to carry out their roles effectively could not be provided. There was no evidence new staff had received a thorough induction to equip them with the skills and knowledge for the role.
There continued to be a lack of systems to assess, monitor and improve the quality and safety of the service. This had led to shortfalls in the management and recording of medicines, risks not always being assessed and recorded, and a lack of documentation of how the Mental Capacity Act 2005 (MCA) had been followed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not always support this practice.
Medicines were not always managed and recorded in line with the provider’s policy and best practice guidelines were not always followed by staff, which led to some shortfalls. The provider could not provide evidence that staff had received appropriate training in medicines management and staff’s competency had not been assessed in this area. We have made a recommendation regarding the safe management of medicines.
Staff were aware of how to recognise and respond to safeguarding concerns. Staff knew people well and could tell us how they would recognise a deterioration in people’s health and how they would respond to certain risks. Staff supported people to access appropriate healthcare and supported them to maintain a diet of their choosing.
Overall, people’s care plans contained appropriate information and detail to direct staff to provide person-centred care. These were not always reviewed and updated as people’s needs changed.
Staff supported people to maintain their independence and treated people with dignity and respect. People and their relatives told us staff were kind caring.
People told us they felt able to raise any issues or concerns. The provider had system in place to manage and respond to any complaints.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staff training and good governance. You can see what action we told the provider to take at the back of the full version of the report.
The service did not have a registered manager in post, they had resigned in January 2017 and the provider had been managing the service since then. 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 there was no clear governance system in place to monitor how the service was operating and drive any improvements needed. For example, there was no auditing programme and shortfalls identified during the inspection had not been identified by the provider.
The provider could not demonstrate that staff had been supported to receive necessary training relevant to their role before they started providing care to people. This meant people could be supported by staff who did not have the right skills and knowledge to meet their needs.
The provider had not carried out all of the required pre-employment checks on staff before they commenced work which meant people were exposed to an avoidable risk.
Sufficient numbers of staff were employed to meet the needs of people who used the service. People told us they received consistent care from a regular care worker who arrived on time and supported them in a caring and unrushed manner.
Procedures were in place to guide staff on the safe administration of medicines. The records we checked showed people had received their medicines as prescribed. We found improvements were needed with the recording of the administration of topical medicines. We have made a
recommendation about the management of this.
Staff demonstrated a good understanding of the Mental Capacity Act 2005 and consent was sought for care support.
People told us they felt safe and staff understood their responsibilities to protect people from the risk of abuse. Risks to people's health and safety were assessed and appropriately managed.
People were supported to eat and drink to promote their wellbeing, and staff supported their healthcare needs where needed.
There were positive and caring relationships between people and staff because staff took the time to get to know the people they supported. People and their relatives were involved in the planning and reviewing of their care. Feedback we received from people and their relatives about the care staff was positive and complimentary. People told us they were treated with respect and individuality by staff who were kind and caring.
Feedback systems were in place where the views of people and relatives were sought. People were given information on how to raise a complaint should they choose to do so. There had been no recorded complaints about the service.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staffing, fit and proper persons employed and good governance. You can see what action we told the provider to take at the back of the full version of the report.