Real Care Solutions

Real Care Solutions Limited is a domiciliary care agency providing care to people in their own homes. It aimed to provide personal care to older and younger adults, autistic people, people with a learning disability, people living with dementia or a with sensory impairment. . At the time of the inspection there were 18 people using the service, 17 of whom received support with 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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not provide personal care to anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Right Support:

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Staff understanding of the principles of the Mental Capacity Act 2005 (MCA) was not strong. There were occasions where these principles had not been applied when choosing to override a person’s decisions about their care.

Staff were passionate about putting people at the centre of their care and recognised the importance of working with them in a way that maintained their independence. People and their relatives said staff really got to know them well, and always tried to do what they could to brighten their day.

Right Care:

Staff did not receive sufficient training to ensure people received the right care in relation to all their needs. However, people and their relatives were complimentary towards the staff and the care they received which they said was kind, caring and considerate. There were enough staff to meet people’s needs so people felt well cared for and never rushed.

Right Culture:

The provider did not have robust systems in place to manage and monitor the quality of the service and to ensure continuous improvements were made. They had not kept up to date with current good practice guidance and regulatory requirements. They were not aware of their responsibilities in this regard, or of the requirement to notify the Care Quality Commission of certain events that took place.

In many ways the provider tried to promote a person-centred culture and worked to provide care to people that made a positive difference to their lives. However, the lack of robust oversight did not always support them to achieve this. People, relatives, and staff all said the management team were approachable, supportive and listened to their views.

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 good (published 5 September 2017). The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

Enforcement

We have identified breaches in relation to safeguarding people from avoidable harm, staff training, consent, and management oversight of the service.

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.

Real Care Solutions provides personal care and support to people living in their own homes. At the time of the inspection 11 people received support from the service however only nine people received the regulated activity of personal care. The other two people received practical support.

The service had 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 and associated Regulations about how the service is run. In this instance the registered manager was also the provider.

People told us staff were very kind and caring towards them and offered support which met their needs and made them feel safe. Staff showed a caring attitude when talking about people and were able to tell us how they delivered individualised care which met people`s needs.

People and relatives told us that the service was extremely caring and often staff and the registered manager went over and above their contractual duties to ensure people received the most effective and personalised care. This had a positive impact on people by improving their quality of life.

People were supported to make decisions for themselves and encouraged to be as independent as possible. People and their representative were involved in planning the support people required. Staff understood how important it was for people to continue to live their life as they chose in their own home and they supported people effectively to achieve this for as long as possible.

Staff and the registered manager recognised people at risk of social isolation and they encouraged and organised the right support for people to access the community.

People were encouraged to retain or regain their independence by staff who recognised how important independence meant for people who often were living on their own. Staff told us they were well trained and mentored by the registered manager who supported them to understand how to provide care and support for people in a dignified way.

Staff told us they were proud to work for Real Care Solution because the care and support they provided to people was value based and did not compromise on the quality of the care people received.

People told us they knew the staff who offered them care and support. If on occasion staff were running a few minutes late they always received a call to let them know when they would be arriving.

The registered manager established good working relationship with other health and social care professionals involved in people`s care. They often supported people to attend appointments and provided vital information to health professionals to ensure people received the best possible care and support which met their needs.

The registered manager used their skills and knowledge which they gained from previous nursing qualification to train staff to recognise early signs if people`s health declined. They always involved the right health care professionals in people`s care which often had a positive impact on people who received the right treatment and prevented their health from worsening.

Peoples` care plans were comprehensive and provided staff with detailed guidance on how to meet people`s needs in a safe and effective way. The registered manager visited every person who received care and support from the service at least once a week to give people an opportunity to give feedback on the service but also to monitor and assess people and ensure there were no changes in their condition.

The registered manager carried out regular audits in areas such as medicines, care planning and health and safety. In addition they regularly done unannounced spot checks when they checked staff`s competencies and the quality of the care provided to people.

The registered manager was a member of a reputable independent care provider association which conducted an independent survey involving people, relatives, staff and other stakeholders in giving feedback about the service they received.