Archived: Carers Elite Limited

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 received safe care and felt safe. People were protected from the risks of abuse and risks to people's health and wellbeing were assessed, managed and regularly reviewed. There were enough staff to ensure that people's needs were met safely. Practices were in place to ensure prevention and control of infection protected people. Improvements had been made to ensure that suitable staff were recruited.

People were supported by staff who had relevant training, skills and experience to care for them. Staff worked with other health and social care professionals to achieve good outcomes for people's health and wellbeing. Where needed, staff monitored people’s intake of food and fluids to ensure they remained healthy.

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.

The staff were caring, and we received positive feedback from people and their relatives. People had supportive and meaningful relationships with staff. People received a service which was caring and respectful. People's rights to make their own choices, independence, dignity and privacy were promoted and respected.

People's care was personalised which met their needs, and their preferences were identified and implemented. People had personalised care plans that promoted independence. People were able to freely complain and could be assured their complaints would be taken seriously and dealt with promptly and professionally.

Staff were motivated and enjoyed positive team work, they felt well supported by the registered manager, although some staff felt the registered manager was overworked and needed to delegate more tasks to others. People told us the registered manager was open and approachable. People, staff and relatives felt their views were listened to. The service was proactive and worked on ways to improve.

We have made a recommendation that the registered manager completes their qualification in social care management without further delay.

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 this service was requires improvement (published 23 November 2018) where we identified a breach of regulation 19 of the Health and Social Care Act Regulations 2014, fit and proper persons employed. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carers Elite 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.

At this inspection we found that improvements had been made and the provider is no longer in breach of Regulations 9, 12,16, 17, and 18. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this home is now out of special measures. We have awarded an overall rating of requires improvement. However, we found that not all the necessary improvements had been made in ensure all the required checks for newly recruited staff had been made. Therefore the provider is in repeated breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 adults. Not everyone using Carers Elite 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.

There was 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.

There were enough staff to keep people safe and to meet their needs. People felt safe when receiving care and support. Systems were in place to protect them from the risk of abuse. Risks to people’s safety and individual needs and preferences were managed well.

Most of the required checks that are made to ensure potential new staff are suitable to work with vulnerable people were completed including a Disclosure and Barring Service check. The provider had not gained the full work history for three newly recruited staff as is required by the regulations. The provider did not have a system to audit that all recruitment checks were in place before applicants started employment. This was addressed and changes implemented during the inspection.

The registered manager and staff had undertaken basic training and improved their knowledge of the Mental Capacity Act 2005 (MCA) since our last inspection. Care records had been improved to include any considerations regarding the MCA although information was very basic. Further work to improve this was on going.

Staff had received training in a number of different areas to provide them with the skills and knowledge to support people effectively. Further training was to be provided to staff regarding dementia care to help them develop their skills further and gain confidence. Staff received adequate support and guidance in their roles.

People’s healthcare was monitored and any needs met. Relationships had been developed with outside healthcare professionals who visited the home regularly in response to any concerns raised.

People were offered choice and were involved in making decisions about their own care. The staff were kind and caring and treated people with dignity and respect. Information about how to complain was on display in the services office and in the service user guide given to people. People and relatives knew how to complain and were confident that any concerns they had would be listened to and acted on.

The staff were happy working at the service, felt supported by their senior and the registered manager and worked well as a team to deliver care to people.

Governance and quality monitoring had improved, but still required further amendments to ensure it was robust. Audits and checks in place to monitor the quality of the service had not found some of issues that were present during our inspection. The registered manager was open to suggestions for improvement and had a plan in place to drive up the quality of the service provided.

The registered manager reviewed the recorded accident and incidents. These were analysed to identify any patterns or trends and plans were put in place to reduce the risk of them happening again in the future.

Services that provide health and social care to people are required to inform the CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Not everyone using Carers Elite Limited receives regulated activity; The Care Quality Commission (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.

There was a registered manager in place. A registered manager is a person who has registered with the 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to person centred care (Regulation 9), safe care and treatment of people using the service (Regulation 12), complaints (Regulation 16), good governance of the service (Regulation 17), staffing (Regulation 18) and fit and proper person employed (Regulation 19). We are taking action against the provider for failing to meet regulations.

Risks to people's health were not always identified. Where they were identified, the service had not always taken appropriate actions to minimise the risks to people's welfare. In some cases, potential risks to people had been inaccurately assessed. People were placed at risk.

The numbers of staff available and their deployment was not effective in ensuring people’s needs were met in a timely way. People had received late and missed calls. These incidents were not recorded accurately and actions to avoid a repeat of these were not always taken.

Staff training and checks of their competency, to ensure that they could meet the needs of people, had not been fully completed. Staff did not receive supervision to support them in their role. Staff had not received appropriate levels of training in dementia awareness and end of life care. Recruitment of staff was not robust.

Staff were kind and caring but did not always respect professional boundaries. Staff sought peoples consent before providing them with support. Staff promoted and encouraged people to be as independent as possible.

People's care plans did not contain accurate, up to date or clear information for staff to help ensure that they provided a safe and good standard of care and support to people. People’s preferences had not always been identified so that staff could provide care in the way people wanted.

Complaints to the service had been not been managed in line with the provider’s stated procedure. They were not used to develop and learn and drive the service forward.

The provider's quality assurance was inadequate and auditing systems were not robust and had not identified the concerns we found during this inspection. Checks were not carried out to ensure that safe, good quality care was provided.

The registered manager had not completed an appropriate qualification as was required at the point of their registration with the CQC. The registered manager did not have sufficient knowledge and understanding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.