Vista Business Centre

Vista Business Centre, known as UK Star Care Ltd, is a domiciliary care agency providing care and support to people living in their own homes. People using the service lived in the county of Surrey. At the time of our inspection 35 people were using the service. The service was registered to provide care to younger and older adults, including people with physical and learning disabilities, people living with the experience of dementia and people with mental health needs. At the time of our inspection, they were providing care to both older and younger adults.

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 using the service were happy with the care and support they received. They told us their needs were met by kind and considerate staff. They had been involved in planning and reviewing their own care, and the agency was responsive when their needs changed.

Care workers had enough time to care for people safely and well. There were appropriate systems for recruiting, training and supporting staff and they felt happy working for the agency. The provider undertook regular checks to make sure staff were suitable and were meeting people's needs.

People's care was planned in a suitable way. Care plans were clear and gave details about their preferences and needs. Risks to their safety and wellbeing had been assessed and planned for. The staff liaised with other healthcare professionals to make sure people received holistic care and support. People received their medicines as prescribed and in a safe way.

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 provider had systems for dealing with accidents, incidents, complaints and safeguarding concerns. They took steps to help make sure people were safe and investigated any concerns, feeding back to people using the service and others. They made changes to improve the service and learn from things that had gone wrong.

There were effective systems for managing the service, including monitoring and improving quality, asking stakeholders for feedback and auditing how care was provided. The registered manager was suitably qualified and experienced and worked with a team of other senior staff who knew people's needs and regularly engaged with them, asking them for feedback about their experiences.

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 4 December 2019). 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 and to follow up on the action we had asked the provider to take.

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.

Vista Business Centre is a domiciliary care service providing personal care and support for people in their own homes. The majority of people receiving support had their care funded by the local authority. At the time of the inspection the service provided support for approximately 28 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

Where a specific issue had been identified during an assessment of a person’s care needs a risk management plan had not always been developed to provide care workers with adequate information to enable them to reduce the risks. This could place people at risk of unsafe and inappropriate care

Medicines were not always managed in a safe way to ensure they were administered appropriately and as prescribed .

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider could not demonstrate that care workers had completed training which enabled them to meet people’s specific care needs in a safe manner.

Records relating to people using the service did not always provide accurate information relating to the care and support they needed. As a result, staff did not always have all the information they needed to care for people.

The provider had quality assurance systems and a range of audits in place, but these were not effective because the provider had not been able to identify and address areas where improvements were required.

People told us they felt safe when receiving care. The provider had processes for recruitment, investigating any concerns raised about the care provided and responding to complaints.

The provider completed an assessment of a person’s care and support needs before they started to receive care from the service.

People felt the care workers individually provided care in a kind and caring way as well as treating them with respect and dignity. The cultural and religious preferences and needs of people were identified in their care plan so staff had the necessary information to care for them appropriately.

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 1 December 2018) and there were repeated breaches of regulation 9 12 and 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needed to make improvements. Please see the Safe, Effective, Responsive and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vista Business Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches of regulations in relation to person centred care, the need to consent, safe care and treatment, good governance and staffing at this inspection. 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 request an action plan for 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.

The last inspection of the service was 12 February 2018 when we rated the service inadequate for the key questions of 'is the service safe?' and 'is the service well-led?' The key questions of, 'is the service effective?', 'is the service caring?' and 'is the service responsive?' were rated as requires improvement. The overall rating of the service was inadequate. We identified breaches of six of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person centred care, need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed. The service was placed in special measures.

Vista Business Centre is the only location for the provider UK Star Care Ltd. 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 older adults and some younger adults who have disabilities. Since the last inspection, the provider moved from a different office location to the Vista Business Centre. At the time of the inspection, 17 people were using the service. They lived in the county of Surrey and their care was commissioned by the local authority.

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 and associated Regulations about how the service is run.

At this inspection, we found improvements had been made in all areas and we have rated the service requires improvement.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

However, we identified some areas where further improvements were needed.

The provider did not always manage medicines in a safe way, although improvements had been made, further improvements were required to make sure risks associated with medicines administration were mitigated.

Some of the care visits did not take place on time. The provider had spoken with the staff about this issue in team meetings, and some people were happy with the timing of the calls. However further improvements were needed to make sure everyone received visits at the right time.

Most people felt their needs were being met, but a small number of people felt that the staff did not always care for them to the level they expected. In particular, the relatives of one person felt that the staff did not have the information or knowledge to meet the specific care needs of their relative.

The provider's audits had not always been effective at identifying where improvements were needed. Although, there had been improvements in this area. The provider had increased their auditing, and in most cases, this had been effective at ensuring the service improved

People using the service were happy with their care workers. The care workers were kind and considerate. They were involved in the development and review of their care plans and were able to feed back their opinions of the service.

The staff were happy and felt supported. They had access to a range of training and regular support from the registered manager and other senior staff.

There was a positive and open culture at the service. People were able to make complaints and felt these were listened to. The provider had responded to information of concern and had learnt from accidents, incidents and complaints.

We found breaches of three of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, person centred care and good governance. You can see what action we have asked the provider to take within our table of actions at the back of the full report.

Sceptre House 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 both older and younger adults. At the time of the inspection it provided personal care to around 26 people in their own homes in Surrey. The majority of people’s care was funded by Surrey County Council.

We previously inspected Sceptre House on 24 and 25 July 2017 and rated it Requires Improvement. We identified breaches of regulations in relation to safe care and treatment (Regulation 12), safeguarding people from this risk of abuse (Regulation 13), good governance (Regulation 17), staffing (Regulation 18) and fit and proper person employed (Regulation 19). We issued warning notices in relation to Regulation 12 and Regulation 17 and asked the provider to meet the regulations by 22 November 2017.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions of ‘Is the service Safe, Effective, Responsive and Well-led?’ to at least good.

At the time of the inspection a registered manager was in post. The registered manager was not available to attend the inspection but knew it was going ahead in their absence. 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.

Information in relation to prescribed medicines that should be administered was not accurate and did not provide appropriate guidance for care workers which meant there were risks that people might not receive their medicines as prescribed.

Risk management plans for risks identified during people’s needs assessment were not in place to provide care workers guidance on how to reduce these risks and ensure people’s safety.

The provider had a procedure for the recruitment of care workers but this was still not being followed, as the provider did not ensure that appropriate references were in place before assessing applicants’ suitability for the role.

Staff were not deployed appropriately as the provider did not always ensure that care workers arrived at the time agreed with the person and stayed the full length of the visits.

New care workers completed induction training but the records of shadowing sessions did not demonstrate the competency of the new care worker had been assessed to ensure they had appropriate knowledge for their role.

The provider had a policy and procedure in place in relation to the Mental Capacity Act 2005 but was not always working within the principles of the Act to ensure people could consent to their care or that decisions were made in their best interests.

Care plans identified the person’s wishes as to how their care should be provided but the records were not updated when a change to the person’s support needs occurred to provide up to date information for care workers.

The provider had audits in place but these did not identify areas where improvement was required. There was no robust system in place to ensure care workers visited people at the planned time and stayed for the agreed length of time.

Most of the people we spoke with told us they felt safe when they received care. The provider had systems for the recording and investigation of incidents and accidents, complaints and safeguarding concerns to identify any trends or required actions.

An assessment of the person’s support needs was completed to ensure the service could meet these needs and provide appropriate care.

Care plans indicated if the person required support from the care worker to prepare meals and identified their preferences for food and drink. These were followed by care workers.

People felt the care workers treated them with dignity and respect when they provided support. The care plans identified the person’s religious and cultural needs as well as information about the person’s background and family to help them meet the person’s support needs.

The provider had a complaints process in place and people knew what to do if they wished to raise any concerns.

Although we found a number of areas that needed to be improved, care workers felt the service was well-led and they were supported by their manager.

At this inspection we found some improvements had been made in some areas. However the provider had also failed to meet breaches in Regulation in relation to person centred care (Regulation 9), need for consent (Regulation 11), safe care and treatment (Regulation 12), good governance (Regulation 17), staffing (Regulation 18) and fit and proper person employed (Regulation 19). You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

Sceptre House is a domiciliary care agency that provides personal care for people in their own homes. At the time of the inspection eight people had their care funded by a local authority with four people funding their own care.

This was the first inspection of the service since it registered with the Care Quality Commission in August 2016.

At the time of the inspection a registered manager was 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.

Risk assessments were not developed to ensure specific risks related to each person were identified and guidance was not provided as to how to reduce any possible associated risks.

The provider had an administration of medicines policy but care workers were not always provided with information on the MAR charts or in the care plans to ensure medicines were being applied in an appropriate and safe way.

The provider had a recruitment process but this was not always followed therefore not providing appropriate information regarding applicants to ensure they were suitable for the role.

The provider had a policy in relation to the Mental Capacity Act 2005 but was not always working within the principles of the Act. Records did not clearly indicate if the person using the service had the capacity to make informed decisions in relation to their care.

The competency of new care workers to complete care tasks was not assessed appropriately during the induction period. Some care workers had completed their induction training a number of months before starting work. This meant the provider could not ensure the new care workers had the appropriate knowledge and skills required to meet people’s care needs safely.

Records relating to care and people using the service did not provide an accurate and complete picture of their support needs.

Regular audits had not been carried out to identify aspects of the service requiring improvement and action had not always been taken to address issues.

People told us they felt safe when they received care in their own home. The provider had processes to respond to any reported safeguarding concerns as well as incident and accidents.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care.

An assessment of people’s support needs was carried out before home care started and care plans identified how people wanted their care provided.

The provider had a complaints process in place and people knew what to do if they wished to raise any concerns.

The person and relative we spoke with felt the service was well-led.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to the safe care and treatment of people using the service (Regulation 12), safeguarding service users from abuse and improper treatment (Regulation 13), good governance of the service (Regulation 17), staffing (Regulation 18) and fit and proper persons employed (Regulation 19). 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.