Archived: We Care Solutions Chorlton

We Care Solutions Chorlton is a domiciliary care provider based in Manchester and provides personal care to adults and older people in their own homes. At the time of our inspection the service supported 44

people.

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

At the last inspection in June 2020 we found there were breaches of five regulations. At this inspection we found the registered person had taken positive steps and implemented systems to improve the quality and

safety of the service provided.

People received care and support that was personalised. A new care planning framework had been introduced. The provider has started the process of re-assessing people’s care planning documentation in order to ensure this fully captured people’s needs. We found steady progress has already been made with the service due to complete this process by the end of February 2021.

There were enough care staff to meet people's needs. Maintaining safe staffing levels had been a challenge at our previous inspection. However, the service has reduced in size and implemented a robust call monitoring system that supported call scheduling.

Medicines were administered in a safe manner. Systems were in place, which monitored how the service operated and ensured staff delivered appropriate care and treatment.

Since our last inspection we found the provider has completed a full-service review of their training resources provided to staff. Feedback from staff during the inspection indicated the training on offer was much improved.

The provider brought in an external consultant to support the service with the necessary improvements. The provider and management team understood that the systems and processes that were now in place were relatively new and further time was needed to ensure that they were fully embedded, and sustained. We will check that improvements made have been sustained at our next planned comprehensive inspection.

People benefited from an improved quality assurance system being in place. This meant that the registered person's oversight of all the service's functions, including recruitment, training, medicines management and

care planning was now more robust.

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 inadequate (08 September 2020). At this inspection we found the registered person had made improvements and the provider was no longer in breach of regulations in relation to the service provided to the seven people who currently use the service.

This service has been in Special Measures since 8 September 2020. During this inspection the registered person demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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

Why we inspected

This was a planned inspection based on the previous rating of inadequate. As part of this inspection we also assessed whether the provider had taken the actions necessary to meet the regulation breaches identified

at the last inspection. Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of Safe and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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

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.

We Care Solutions Chorlton is a domiciliary care provider based in Manchester and provides personal care to adults and older people in their own homes. At the time of our inspection the service supported 152 people. 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

People’s visit times were cut short, and visits were frequently late. This impacted negatively on people’s experience of their care. There was a failure to assess and identify the risks involved in the delivery of care to people. This put people at risk of harm and poor care.

The service had failed to raise standards since the last inspection. A poor management culture provided poor oversight of the service. Late visits and call cramming had become the norm. Poor care planning processes and procedures put people at risk of unsafe care. The service was not person centred and dealt poorly with people’s complaints.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was requires improvement (published 16 July 2019) with breaches in Regulations 17 (Good governance) and Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and a further four regulations.

Why we inspected

We received concerns in relation to missed visits, late visits and the management of catheter care, choking risks, care planning and medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 9 Person-centred care, Regulation 12, Safe care and treatment, Regulation 13, Safeguarding service users from abuse and improper treatment, Regulation 17, Good governance and Regulation 18, Staffing. This is the fourth consecutive inspection in which this service has been in breach of regulations.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work with the 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We Care Solutions is a domiciliary (home care) agency providing care and support to people living in their own homes. Most of the people using the service were older adults who received support with personal care. At the time of our inspection, there were 135 people using the service. The service had increased in size since our last inspection in February 2018 when they were providing support to approximately 65 people.

People’s experience of using this service:

Other than some complaints about the timeliness of calls, people’s feedback about the service was very positive. People told us that the staff providing their support knew them well, understood their needs and treated them with kindness and respect.

Whilst feedback was mixed, some people told us their calls were not always on time. Records also showed that calls could sometimes be earlier or later than the provider’s target of carrying out calls within half an hour of the given time. In a small number of cases, staff may not have been able to attend all their scheduled calls on time as they overlapped with the previous one.

Staff received a range of relevant training and people using the service felt they were competent to meet their needs. Staff told us they received adequate support, although we found staff supervision was infrequent.

Staff assessed people’s needs and involved people in developing and reviewing their planned care. However, records did not always accurately reflect the current support staff were providing. This included the measures staff were following to keep people safe from harm.

People told us staff knew their preferences and provided support the way they wanted. Care plans were written in a person-centred way that would help staff understand people’s preferences.

People told us they would feel comfortable raising any concerns or complaints they had with staff or the registered manager. We found the provider identified any complaints and acted to put things right when needed. The complaints policy needed to be reviewed to help ensure people were aware how they could escalate their complaints if they were not satisfied with the outcome.

The registered manager and provider had a good understanding of the needs of the people using the service, as well as any challenges faced by the service. There was a clear vision for the future direction of the service.

The service had not consistently followed robust procedures to ensure staff recruited were of good character. We also found records were not always clear and accurate, particularly in relation to the administration of medicines, which was an ongoing issue.

The service had not notified the CQC of all incidents they were required to.

We made three recommendations. These relate to the provider’s complaints procedures, and that they review and implement good practice guidance in relation to end of life care and staff support/supervision.

Rating at last inspection and update:

We last inspected the service in February 2018 when it was rated requires improvement (report published 17 May 2018). This is the third consecutive time the service has been rated requires improvement.

At our last inspection we found one breach of the regulations relating to the provider not displaying their performance rating on their website. The provider was now meeting the requirements of this regulation.

Why we inspected:

This was a routine planned inspection schedule based on the rating from our last inspection.

Enforcement:

We have identified breaches in relation to staff recruitment procedures, the keeping of complete and accurate records of care and the requirement to notify the CQC of specified incidents.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor the service.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We previously inspected this service in December 2016 when it was registered as 'Chorlton' with the Care Quality Commission (CQC). At that inspection we had discussed with the provider changing the registered name to reflect what the service is usually called. At this inspection we saw that the provider had changed the registered name to We Care Solutions Chorlton.

At our last inspection we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve to at least good in the following areas : assessing the needs and preferences of service users; the need for consent; operating effective systems to assess, monitor and improve the quality of the service and ensuring that fit and proper persons were employed.

The service is a domiciliary care agency providing care and support to people living in their own homes. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Their office is in Chorlton in south west Manchester. At the date of this inspection they had approximately 65 people using the service in the Chorlton and Wythenshawe areas of Manchester.

Not everyone using We Care Solutions receives 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.

A registered manager was in post at the time of our inspection. 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.’

Scheduled visits had been placed into ‘runs’ for care workers, mainly based on geographical location and individual need. The allocation of runs had contributed hugely in streamlining the service.

The service had introduced technology to assist with call monitoring. Monitoring logs reflected most staff were logging in and out and staying for the full duration of the call but some staff were not. Checks were not being done in real time following any unlogged calls and this meant the provider could not be assured that the call had taken place. During our inspection the provider put mechanisms in place to follow up on any unlogged calls once these were alerted on the system.

People were happy with the support they received with their medicines. If prescribed medicines were contained in blister packs then staff were able to administer, as per company policy. Not all MAR’s were accurately completed and the service had identified this during monthly audits and addressed this with staff. .

At our previous inspection we identified issues around the timing and allocation of people’s care visits and the high number of care workers allocated to individuals. At this inspection we saw that improvements had been made in all of these aspects and the feedback we received from people confirmed this.

Care workers were vigilant in terms of identifying and reporting any concerns they had regarding the people they supported. Following a safeguarding referral and subsequent investigation in 2017 the service had taken appropriate action in dealing with staff. The service was taking the necessary action to report and act on safeguarding concerns.

Care workers received a thorough induction, were well trained for the role and employees new to adult social care were signed up to the Care Certificate. Staff received spot checks from senior care workers to assess their performance and competence in their roles. Supervision sessions were recorded formally and care workers we spoke with appreciated supervisions and saw them as an opportunity to raise any concerns or discuss how they were feeling with a supervisor.

The provider had visited all clients in October and November 2017 to gauge people’s capacity in relation to their care. Staff had received training on the mental capacity act and could give examples of how they obtained consent from people prior to assisting them with personal care. The service was now acting in accordance with the Mental Capacity Act 2005 and meeting the regulation.

Staff understood the needs of the individuals they supported. staff were polite, kind and respectful. Everyone we spoke with confirmed that staff always stayed for the allocated time and if commissioned duties were finished staff would find usually something else that needed doing.

Care workers respected people’s privacy and dignity and gave us examples of how they did this. Staff also recognised the importance of encouraging people to be independent and how this benefitted the people they supported.

The service was exploring new ways of working, including an increased use of technology whilst ensuring confidentiality in relation to people’s personal information was maintained.

People had been very much involved in writing their plan, alongside the assessor as care plans were person centred and written from the ‘I’ perspective. People had received an initial assessment where they were asked what support they required and what their preferences were.

People felt confident they could change their care plans if they wanted to. People were involved in planning and individualising their own care and confirmed that they could change this as the service was flexible in their approach.

The service regarded complaints as an opportunity to learn and improve. The service investigated and resolved formal complaints in a timely manner and acted upon informal feedback to resolve problems.

The rating from the previous inspection was clearly displayed in the office. Prior to our site visit we checked the provider’s website to see if the current rating of the service was displayed and it was not. Failure to display the current rating of the service on the company’s website is a breach of Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Systems to monitor and assess the overall quality of its care provision had improved. Audits had identified the improvements needed and these were addressed with staff.

There was a formal system for seeking feedback on the service they provided from people and their families. Where feedback was not positive the service acted accordingly and acknowledged the feedback. The service responded positively to criticism and looked to make improvements to provide a better quality service.

The provider was proactive in working in partnership with the local authority and implementing new processes and procedures in order to improve the service. The Chorlton office was well staffed and was using modern technology to improve the quality of the service.

You can see what action we told the provider to take at the back of the full version of the report.

This was the first inspection of this service. There had been a previous service run by the same provider since July 2014, which had moved offices in January 2016 and become registered as ‘Chorlton’ in March 2016.

‘We Care Solutions Manchester Limited’ is the name of the provider and is the name by which the service is generally known. ‘Chorlton’ is the name of the service registered with the Care Quality Commission (CQC), and therefore is the name used in this report. We discussed with the provider changing the registered name to reflect what the service is usually called.

The service is a domiciliary care agency providing care and support to people living in their own homes. Their office is in Chorlton in south west Manchester and they provide the service around the Chorlton area and also in Wythenshawe. At the date of this inspection they had approximately 30 people using the service in the Chorlton area and 20 people in Wythenshawe.

The service had a registered manager who had been registered since March 2016, and had previously been registered with the predecessor service. 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 some checks of potential employees were made, but that some staff had been allowed to work on their own without a valid Disclosure and Barring Service (DBS) certificate. This was a breach of the regulation relating to employing people of good character.

Staff had been trained to use equipment and the people we spoke with felt safe when they were being moved.

People were told that staff would arrive within a half hour window, and this meant that late visits were rare. There had been one missed visit during 2016 but measures had been taken to prevent a recurrence. Support workers were using a new system to log in and out of calls via their mobile phones. This system had not yet fully bedded in, and was not being used in the Wythenshawe area. We have made a recommendation that the provider installs a reliable system to prevent missed or significantly late calls.

There was usually consistency with the same staff providing support, which provided reassurance to people using the service. Staff had been trained in safeguarding and knew what signs of abuse to look out for. The provider had reported incidents appropriately. This meant that people were protected from the risk of abuse.

Some people received assistance with medication. Staff were trained in this area and we gained evidence that they recorded the medicines they had given correctly.

Staff had received training in the Mental Capacity Act 2005 (MCA), and the staff sought consent for care interventions. However, if people lacked capacity or might lack capacity to make their own decisions, the service did not carry out coherent mental capacity assessments. This was a breach of the regulation about acting in compliance with the MCA and potentially meant that people could be receiving care or support where consent had not been obtained in the correct way.

There was an induction training package for new recruits which included shadowing existing support workers. Staff then took the Care Certificate. There was also training for experienced staff. There was no overall record which showed what training all the staff had received.

Staff supported people when appropriate to access health services. They were trained in food hygiene in order to assist some people with food preparation.

People receiving the service gave, on the whole, very positive feedback about the staff and the support.

People told us that staff catered for their emotional needs as well as the physical, and sometimes went beyond what they were expected to do. They encouraged people’s independence and helped them maintain their hobbies and interests.

We saw from training documents that the staff were taught to treat people with dignity. People we spoke with confirmed they were treated respectfully. Care files were treated as confidential.

We looked at care plans and found them to be very basic, in some cases merely reproducing the information supplied by the council. There was little or no information which would enable staff to deliver person-centred care. Nor was there any evidence on the files that care plans had been reviewed, although some people told us that staff had discussed their plan with them.

The care plan template was not adapted to make it suitable for use. Risk assessments and medication plans were not kept with the care plan so it was difficult to form a complete view of a person’s care needs. The deficiencies in care planning were a breach of the regulation relating to meeting people’s needs.

The service was responsive to people’s preferences to have a support worker who spoke a particular language, where possible.

There was a policy for dealing with complaints, and we saw that these were responded to and recorded. People receiving the service and most staff expressed satisfaction with the management of the service. A local social worker who commissioned care packages was also very positive about how the service was run.

The Chorlton office was well staffed and was using modern technology to improve the quality of the service. The staff in Wythenshawe were managed differently and used less advanced systems, which created the risk of inconsistency in the quality of the service.

The system of care planning audits was defective as there was no accurate record of which files had been audited, and no record of what the audit involved. The breaches of regulations at this inspection indicated that the quality monitoring of the service required improvement. This was itself a breach of the regulation regarding assessing and monitoring the quality of the service.

A questionnaire had been used in August 2016 to gain people’s views about the service, and had resulted in some improvements. Spot checks were used regularly to monitor staff performance.

We found breaches of four regulations 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 end of the full version of the report.