Sihara Care

Sihara care is a domiciliary care agency providing personal care to people living in their own homes. The services they provide include personal care, housework and medicines support. At the time of our inspection the service was providing personal care and support to a total of 54 people. 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:

Areas of potential risks to people were not always identified and appropriate risk assessments were not always in place. Some risk assessments lacked detail. This could result in people receiving unsafe care and we found a breach of regulation in respect of this.

Appropriate medicines management and administration processes were in place.

People who received care from the service told us they felt safe and supported in the presence of care workers. There were systems in place to help safeguard people from the risk of possible harm.

There was a recruitment system in place. However, we noted that it was not always clear who provided references for newly recruited staff. We have made a recommendation in respect of this.

Measures to prevent and control the spread of COVID-19 and other infections were in place.

People and relatives told us that care workers were respectful of people’s privacy and dignity. They told us care workers were kind, helpful and considerate.

Staff were up to date with their training, which ensured they had the knowledge and skills to safely and effectively meet people's needs. However, we noted that in some staff records there was a lack of detail about what was discussed during supervision sessions and have made a recommendation in relation to this.

The service had a system in place to monitor the quality of the service being provided to people. However, we found that there were some instances where the service failed to effectively check various aspects of the care provided and identify deficiencies with aspects of care. For example, the service had failed to identify issues in respect of risk assessments, care plans and staff recruitment. We found a breach of regulation in respect of this.

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.

People's care plans we looked at included details about people's medical background, details of medical diagnoses and social history. Care support plans we looked at were specific to each person. However, the level of detail in each person's care records varied and information was not consistently recorded. We also noted that a number of care plans had not been reviewed since 2020.

Systems were in place to take learning from any suggestions or complaints, should these be made.

Staff we spoke with told us they enjoyed working at the service and they were well supported by the management team and their colleagues.

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 the service was good (16 March 2021). Since the previous inspection, the provider has been taken over by different provider and is under new management, although it is the same legal entity running the service.

Why we inspected

This was a planned comprehensive inspection to review the key questions, Safe, Effective, Caring, Responsive and Well-led and rate this service.

The inspection was prompted because the service has not had an inspection since the change in provider and management.

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified two breaches in relation to safe care and treatment 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 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.

Sihara care is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection the service was providing personal care and support to a total of 58 people. 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 who received care from the service told us they were well supported by care workers. This was confirmed by relatives we spoke with. They told us people were safe. Systems were in place to safeguard people from the risk of possible harm. Staff we spoke with understood their responsibilities with regards to safeguarding people. The service had safe recruitment procedures in place.

Our previous inspection found medicine records were not consistently completed and appropriate systems were not in place. We found a breach of regulation in respect of this. During this focused inspection, we found the service had taken appropriate action to address the issues previously identified. Medicines were managed safely.

Our previous inspection identified that appropriate risk assessments were not always in place and we found a breach of regulation in respect of this. During this focused inspection, we found that the service had taken action to improve this. Appropriate risk assessments were in place and covered areas such as the environment, physical health and personal care. These also contained guidance for minimising potential risks associated with the COVID-19 pandemic.

The majority of feedback obtained indicated that there were no issues with care worker’s punctuality and attendance. The service monitored punctuality using an electronic call monitoring system. Our previous inspection found that the system was not working effectively. However, during this inspection we found that the service had addressed this.

Care workers we spoke with told us that they felt supported by the registered manager. They told us that management were approachable and they raised no concerns in respect of this.

People were supported to maintain good health and access healthcare services when needed. People were supported with their nutritional and hydration needs. Feedback from people and relatives indicated that care workers were kind, compassionate and caring.

People and relatives confirmed they were involved in their care and feedback was actively sought about the quality of the care provided.

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.

Procedures were in place to respond to complaints.

Our previous inspection found that there were some instances where the service failed to effectively check various aspects of the service and we found a breach of regulation. During this focused inspection, we observed that the service had made improvements and had an effective system in place to monitor the quality of the service being provided to people.

Rating at last inspection

The last rating for this service was requires improvement (published 18 February 2020).

Why we inspected

We previously carried out a comprehensive inspection of this service on 7 January 2020. 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 safe care and treatment 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 Safe, Caring, Responsive and Well-led.

The ratings from the previous comprehensive inspection for the key question 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 requires improvement to good. 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 Fairmount 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.

Sihara care is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection the service was providing personal care and support to a total of 78 people. 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

Medicines were not always managed safely. Medicines records contained unexplained gaps and lacked information in relation to topical creams and ‘as and when required’ (PRN) medicines. The service did not have robust processes to ensure that medicines were managed appropriately and we found a breach of regulation in respect of this.

Risk assessments were completed for people. However, some areas of potential risks to people had not been identified and appropriate risk assessments were not in place.

People who received care from the service told us they felt safe and supported in the presence of care workers. There were systems in place to safeguard people from the risk of possible harm. Staff understood their responsibilities with regards to safeguarding people. The service had safe recruitment procedures in place.

The majority of people and relatives spoke positively about care worker’s punctuality and attendance. The service monitored punctuality using an electronic call monitoring system. However, we noted that this was not working effectively as care workers were not always logging in when arriving at people’s homes and logging out when leaving. We discussed this with the manager and director who advised that this was an area that they had already taken action in respect of but would ensure they improved this further.

Care workers we spoke with told us that they felt supported by the manager. They told us that management were approachable and they raised no concerns in respect of this. Staff had completed training relevant to their role. We noted that staff received supervision sessions but we found these did not occur consistently. We also noted that some staff appraisals were overdue.

People were supported to maintain good health and access healthcare services when needed. People were supported with their nutritional and hydration needs. People told us care workers were kind and caring.

People and relatives confirmed they were involved in their care and feedback was actively sought about the quality of the care being provided.

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.

Care workers were aware of the importance of treating people with respect and dignity. Feedback from people indicated that positive and close relationships had developed between people who received care from the service and their care worker. The majority of people we spoke with praised their care workers for their caring attitude and helpful approach.

Staff we spoke with told us they enjoyed working at the service and they were well supported by the management team and their colleagues. There were procedures in place to respond to complaints.

The service had a system in place to monitor the quality of the service being provided to people. However, we found that there were some instances where the service failed to effectively check various aspects of the care provided and identify deficiencies with aspects of care. For example, the service had failed to identify issues in respect of the completion of MARs and risk assessments.

Rating at last inspection

The last rating for this service was good (published 10 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014 in relation to safe care and treatment 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 work alongside the provider and 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.

Sihara Care is a domiciliary care agency registered to provide personal care to people in their own homes. The service focuses on providing reablement services to adults with physical and mental health problems. At the time of the inspection, the service was providing care to 27 people.

Since the previous inspection, the registered manager moved to another role within the service. At the time of the inspection on 11 July 2017, a manager had been appointed and commenced their role on 10 July 2017. The provider explained that the new manager would make an application to register with the Care Quality Commission (CQC) in due course. 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.

The last comprehensive inspection we carried out in August 2016 found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection in July 2017, we found that the service had taken appropriate action to improve on the breaches of regulation we previously identified.

People and their relatives informed us that they were satisfied with the care and services provided by the service. People told us they felt safe around care staff and were treated with respect and dignity. Relatives of people who used the service said they were confident that people were safe around care staff and raised no concerns in respect of this.

The inspection in August 2016 found that risk assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. During the inspection in July 2017, we found that the service had made improvements to risk assessments. Risk assessments detailed potential risks to people, the warning signs and information for staff on how to support people appropriately.

Systems and processes were in place to help protect people from the risk of harm. The inspection in August 2016 found that the majority of staff were unable to describe the safeguarding and whistleblowing process. During the inspection in July 2017, we saw documented evidence to confirm that care staff had received refresher safeguarding and whistleblowing training. Staff we spoke with during this inspection knew how to recognise and report any concerns or allegations of abuse.

During the inspection in August 2016, we found the service was not completing Medication Administration Records (MARs) when administering medicines to people and people were therefore at risk of not receiving their medicines safely. We found a breach of regulation in respect of this. During the inspection in July 2017, we found that the service had taken appropriate action in respect of this. Staff had received training on the administration of medicines and the service introduced MARs when administering and prompting people with their medicines and these were being completed by care staff.

During the inspection in August 2016, we found that some of the training provided to care staff was not effective as it was evident that there were deficiencies in their knowledge and we found a breach of regulations in respect of this. During the inspection in July 2017, we found that the service had taken appropriate action to improve this. We saw documented evidence that staff had received refresher training. Further, care staff we spoke with were able to demonstrate that they had an understanding of the areas covered during their training. Staff also received supervisions and appraisals. The provider confirmed that they would ensure these were carried out consistently for all staff.

Care staff we spoke with told us that they felt supported by management. They said management were approachable and they raised no concerns in respect of this.

People using the service told us that they experienced consistency in the care they received and generally had regular care staff. People also told us that care staff were generally punctual and raised no concerns in respect of this.

The service tried to ensure care staff were matched with people who came from the same culture where possible so that they could better understand the needs of people. People we spoke with spoke positively about this aspect of the care.

During the inspection in August 2016, we found that care plans lacked information about people’s mental health and their levels of mental capacity to make decisions and provide consent to their care and we found a breach of regulation in respect of this. During the inspection in July 2017, we found that the service had taken action in respect of this. The service had reviewed people’s care plans and these now included information about people’s mental health and their levels of mental capacity to make decisions and provide consent to their care. Information about people’s communication needs were also documented.

The inspection in August 2016 found that there was limited information in care support plans about the support that people required from care staff. We also found that there was a lack of clear instructions for care staff about what tasks needed to be carried out and we found a breach of regulation in respect of this. During the inspection in July 2017, we saw evidence that the service had reviewed care support plans and had amended these so that they included details and specific information about how to support people to meet their needs as well as guidance for care staff in respect of meeting these needs.

During the inspection in August 2016, we found that the service did not have a system in place to monitor the quality of the service being provided to people using the service and to manage risk effectively. During the inspection in July 2017, we found that the service now had effective systems in place to check essential aspects of the care provided. The service had introduced quality and audit checks.

We undertook a focused inspection on the 15 November 2016 to check whether the service had met the warning notice and to confirm that they now met legal requirements. We inspected the safe and well led domain only at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Sihara Care' on our website at www.cqc.org.uk'.

Sihara Care is a domiciliary care agency registered to provide personal care to people in their own homes. The service focuses on providing reablement services to adults with physical and mental health problems. At the time of the inspection, the service was providing care to 15 people.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At this focused inspection on 15 November 2016, the service demonstrated that they had taken sufficient action to comply with the warning notice and that the legal requirements had been met.

We found that risk assessments included more detail and reflected potential risks to people. We saw evidence that the service had implemented new format moving and handling risk assessments and medication administration assessments.

We also found that the service now had systems in place to assess and monitor the quality and safety of the services provided, to mitigate risks to the health, safety and welfare of people using the service, and to ensure that records relating to service users were accurate and complete.

However, we need to be sure that the service is able to demonstrate that they are able to consistently meet both Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will therefore look at these Regulations again at the next comprehensive inspection we carry out.

Sihara Care is a domiciliary care agency registered to provide personal care to people in their own homes. The service focuses on providing reablement services to adults with physical and mental health problems. At the time of the inspection, the service was providing care to 29 people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Sihara Care was previously registered with the CQC at a different address. In May 2016 they moved to their current address. This was the first inspection of the service since their change of address.

The majority of people who used the service told us that they felt safe around care workers. People told us that they were treated with respect and dignity when being cared for by care workers.

Individual risk assessments were completed for people. However, the assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. This could result in people receiving unsafe care and we found a breach of regulations in respect of this.

There were processes in place to help ensure people were protected from the risk of abuse. Despite receiving safeguarding training, the majority of staff we spoke with were unable to describe the process for identifying and reporting concerns and were unable able to give example of types of abuse that may occur.

There were some arrangements to manage medicines safely and appropriately. Records showed care workers had received medicines training and medicines policies and procedures were in place. However, we found the service was not completing Medication Administration Records (MARs) when administering medicines to people. People were therefore at risk of not receiving their medicines safely and we found a breach of regulation in respect of this.

Care workers we spoke with told us that they felt supported by the registered manager. They told us that management were approachable and they raised no concerns in respect of this. However we found that care workers lacked knowledge of certain areas of care. Some of the training provided to care workers was not effective as there were deficiencies in their knowledge. Staff received supervisions but we noted that this was not consistent for all care workers. Staff had not received an appraisal in the last year. We found that there was a breach of regulations in respect of this.

People using the service told us that they experienced consistency in the care they received and generally had regular care staff.

Appropriate checks were carried out when staff were recruited.

Care plans lacked information about people’s mental health and their levels of mental capacity to make decisions and provide consent to their care. There was no information in people’s care plans which showed how people who had limited capacity or were not able to verbally communicate were supported to make decisions and how their consent was gained. We found a breach of regulation in respect of this.

The registered manager explained that the service aimed to provide good quality care and promoting high standards where people’s rights were paramount. We saw that the aims and objectives of the service as detailed in the service user guide reflected this ethos. The registered manager told us that the focus of the service was on providing care that has positive outcomes for them and providing top quality services.

There was limited information in care support plans about the support that people required from care staff. The information included in people’s care plans was task-focused. We found that there was a lack of clear instructions for care workers about what tasks needed to be carried out. We found a breach of regulations in respect of this.

The service had a complaints procedure in place. During the inspection we were informed of a complaint that had been raised by a person who used the service. However, we found that this complaint had not been recorded. We have made a recommendation in respect of this.

We found that the service did not have a system in place to monitor the quality of the service being provided to people using the service and to manage risk effectively. The service had failed to effectively check essential aspects of the care provided and did not have a quality and audit overview of the service. We found a breach of regulations in respect of this.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what further action to take. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.