ICRIT Healthcare

ICRIT is a domiciliary care agency, providing personal care to people living in their own homes in the community. They provide support to; older adults, including people living with dementia, people with physical disabilities, and people with learning disabilities. At the time of our inspection there were 23 people receiving a service.

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

Systems for safeguarding people who used the service from abuse were robust, training was given to staff and their knowledge was good. The service had appropriate general and individual risk assessments in place. Medicines were managed safely and staff were trained to an appropriate level.

Staff were recruited safely and staffing levels were sufficient to support the people who currently used the service. However, some people felt there was an issue with staff sometimes turning up late to visits. The induction programme and on-going training equipped staff for their roles.

Thorough assessments were carried out and care plans included a range of relevant health and personal information. People’s nutritional and hydration needs were assessed and their dietary requirements and preferences recorded and adhered to.

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. However, records around MCA and consent could have been clearer.

People we spoke with and their relatives felt they were treated well and their diversity was respected. People’s dignity and privacy was respected by staff. Some people had a little difficulty with communicating with care workers, if English was not the staff member’s first language.

People’s care was person-centred and care and support needs were reviewed and updated on a regular basis. Complaints were logged and followed up appropriately. The service was able to link in with other agencies in order to support people nearing the end of their lives.

The service monitored complaints, safeguarding concerns, notifications, accidents and incidents on a weekly basis. Lessons learned were shared with staff via monthly team meetings and supervision sessions.

Staff told us they felt well supported by the management team. The service worked well with other professionals and agencies to produce joined up care and support.

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

At the last inspection in published on 22 October 2018 the service was found to be in breach of the regulations in relation to governance, and was rated as requires improvement overall. The service submitted an action plan which described the actions they would take to improve the service. We reviewed how this had progressed at our inspection and found they were no longer in breach of this regulation.

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.

ICRIT is a domiciliary care agency, providing personal care to people living in their own homes in the community. They provide support to; older adults, including people living with dementia, people with physical disabilities, and people with learning disabilities. At the time of our inspection there were 27 people in receipt of a regulated activity.

At the last inspection in September 2017 the service was found to be in breach of the regulations; in relation to staffing and governance, and were rated as requires improvement overall. The service submitted an action plan which described the actions they would take to improve the service. We reviewed how this had progressed at our inspection. We found there had been significant improvements in the training staff received and they were no longer in breach of this regulation. There were some ongoing concerns in relation to governance.

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 supported by shift coordinators and senior care staff.

The service had not consistently met peoples' needs safely. One person had been assessed as needing two carers to support them with all transfers but told us, that until recently, transfers had regularly been performed by one carer. A visiting social worker had raised a safeguarding concern. Bolton Council had suspended the commissioning of new packages of care until the safeguarding investigations had been concluded. We were confident the person had been supported safely since then because the procedure had been improved. The person told us they were always supported by two carers now.

Staff were knowledgeable about how to protect people from the risk of harm and abuse. Staff knew how to recognise and raise any safeguarding concerns. Risk assessments had been completed in people's care plans and had been reviewed and updated regularly.

Staff had been recruited safely with all necessary checks completed before they started working with people who used the service.

There were sufficient staff to support people safely. Staff we spoke with confirmed this. People who received a package of care also confirmed staff were not rushed. Medicines were managed safely. Staff had received training in infection control and could describe the steps they took to minimise the risks of infection.

Accidents and incidents had been recorded and actions taken to ensure the risk of reoccurrence was minimised. Lessons learned from incidents were recorded and discussed in team meetings.

People's needs were assessed prior to their package of care starting. Assessments included all the persons' health and social care needs. People, their relatives and other professionals had been involved in the assessment and care planning processes.

Staff who had started working for the service since the last inspection praised the quality of the induction programme they had undertaken. People who used the service said they felt staff were knowledgeable and knew how to support them.

There was a supervision policy in place. We could see staff had received supervision regularly to discuss their practice and development. Staff we spoke with reported benefitting from regular supervision.

At the time of this inspection no one was subject to restrictive practices amounting to a deprivation of liberty. The service continued to work within the principles of the Mental Capacity Act 2005. People had signed consent to receive care and support. Staff understood the importance of getting people's consent before they provided personal care or support.

Where it had been agreed as part of their package of care, people had been supported with meal preparation and to maintain their nutrition and hydration. Records of food and drink prepared and consumed had been completed.

Some people had equipment in their homes to support them with the activities of daily living, and mobility. Guidance on the use of equipment had been provided for staff. Staff received practical training on the use of hoists and other mobility aids, from Bolton Council, prior to supporting people with this. We found one person's mobility plan had not been followed. We were confident this had been addressed.

We observed staff supported people in their homes in kind and caring ways. People we spoke to told us they found the staff to be caring and patient. Staff we spoke with told us how important they considered their role in caring for people in ways they would value themselves.

People's cultural and religious backgrounds had been discussed with them and recorded in their care plans. Any specific support a person needed to maintain their identity needs had been detailed. Staff were knowledgeable about the principles of equality and who might be considered to have a protected characteristic as described in the Equality Act 2010.

There was a policy about advocacy and the use of advocates but at the time of this inspection no-one had been assessed as needing an advocate.

People were encouraged to share their views and raise their concerns. A service user survey had been completed since the last inspection and showed a high level of satisfaction in relation to the care people received.

People received care that was personalised and responsive to their needs. Care plans had been developed which reflected their needs and preferences. People's needs were reviewed and care plans updated to reflect any changes. Staff we spoke with knew how to recognise changes and how to report them.

There was a complaints policy. Where complaints had been made we could see these had been fully responded to. A log of complaints had been maintained. People we spoke with said they knew how to raise any concerns they might have and, when they had raised anything, felt it had been responded to.

The service did not routinely provide end of life care. Where they had been involved in providing this support, since the last inspection, the lead had been taken by community health professionals. The registered manager advised they were looking to improve their knowledge and skills in relation to this aspect of care and had arranged for some training. We will review progress at the next inspection.

There was a clear management structure in place. Staff were aware of what was expected of them in relation to the standards of care they provided and their own professional behaviour. Staff we spoke with said they found the management team were easy to contact and were supportive.

Governance systems had not always ensured the management had oversight of all aspects of service delivery. A recent safeguarding concern raised by a social worker in relation to moving and handling practice, showed the management had not realised staff had failed to follow the agreed risk assessment.

Other auditing completed, which included spot checks of care practice and records, had been done regularly by the registered manager. We saw where any concerns had been identified these had been addressed and appropriate action taken.

At the previous inspection the service had been found to have not submitted all the required notifications to CQC in a timely way. We found this had occurred again when a notification had not been submitted as soon as the registered manager had been aware of an incident. In addition, the registered manager had not been aware of all of the events they were obliged to notify CQC of.

The service's CQC report and rating was displayed in the office and on the services' website.

ICRIT Healthcare is a privately owned domiciliary care agency. They are situated in Bolton. The agency provides care staff to support people in their own homes. They provide assistance with tasks such as personal care, food preparation, medication administration and household chores. The service supports people around Bolton. Services are provided to older adults, adults with physical disabilities, adults with memory loss or living with dementia, adults with complex needs and adults with specific conditions such as substance misuse. At the time of our inspection the service supported 15 people and employed 11 care staff.

The service had 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.

This inspection was the first inspection since the service was registered with the Commission on 10 February 2016. During this inspection we found the service was in breach of two regulations relating to staff training and development and good governance. These were breaches of regulation 17 and 18 of the Health and Social Care Act Regulated Activities (Regulations) 2014 with regards to good governance and staffing.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found there were policies and procedures on safeguarding people. Five staff had received training in safeguarding adults and they showed awareness of signs of abuse and what actions to take if they witnessed someone being ill-treated.

Concerns were raised by local commissioners and safeguarding professionals regarding risks associated with moving and handling people. Safeguarding incidents had been investigated and documented, showing the support people were getting after incidents. Staff had sought advice from other health and social care professionals where necessary. Internal investigations had been undertaken where incidents had been reported. There were risk assessments which had been undertaken. Plans to minimise or remove risks had been drawn and reviewed in line with the organisation’s policy. Improvements were required in this area to ensure that risk assessments were robust and covered all risks associated with people’s care and treatment.

Lone working and environmental risk assessments were in place to ensure the safety of care staff and people they support. During the inspection we observed staff were visiting people at the planned and agreed times. There was a system for checking whether staff had visited as planned which had been implemented and monitored.

There was a medicines policy in place and staff had been trained to safely support people with their medicines.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. These had been followed to ensure staff were recruited safely for the protection and wellbeing of people who used the service. Records we saw and conversations with staff showed the service had adequate care staff to ensure that people's needs were sufficiently met.

We found care planning was done in line with the Mental Capacity Act, 2005. Staff showed awareness of the Mental Capacity Act, 2005 and how to support people who lacked capacity to make particular decisions. However consistence was required in the records and provider had not provided staff with training this area.

The feedback from people about care staff and the organisation was positive. However people told us wanted to be kept informed when staff had been delayed.

People using the service had access to healthcare professionals as required to meet their needs. Staff had received training deemed necessary for their role. However there were shortfalls in a number of areas and in house training was not robust. Staff competences were checked regularly in various areas of practice including, medicine administration and food hygiene. Staff had received supervision through spot checks and supervision meetings at the office.

We found that people’s care needs were discussed with care commissioners before they started using the service to ensure the service was able to meet their assessed needs. Care plans showed how people and their relatives were involved in discussions around their care. People were encouraged to share their opinions on the quality of care and service being provided. People’s nutritional needs were met. Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

There were established management systems at the service. Senior management had been involved in the running of the service. The registered manager had provided oversight duties they delegated to other staff.

Quality assurance systems were in place and some areas of people’s care had been audited regularly to identify areas that needed improvement. We found audits had been undertaken of daily care records, and medicine administration records. However systems and processes for assessing the quality if the service were not robust to ensure audits were taken for the quality of the care records, staff recruitment files and staff training needs. Improvements were required to demonstrate good governance.

There was a business contingency plan to demonstrate how the provider had planned for unexpected eventualities which may have an impact on the delivery of regulated activities.

Surveys we saw showed people felt they received a good service and spoke highly of their staff. Relatives told us the staff were kind, caring and respectful. Two professionals we spoke to confirmed this. However two other professionals provided mixed feedback regarding the quality of the care documentation.

We found the service had a policy on how people could raise complaints about their care and treatment.