Immaculate Healthcare Services Limited Croydon

Immaculate Healthcare Services Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of this inspection it provided a service for 102 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 and their relatives told us they felt safe and were protected from the risk of abuse. The service had safeguarding procedures in place that staff were well aware of. Staff received training on safeguarding people.

Risk assessments and risk management strategies were in place as part of the assessment and support planning process. This meant risks to people and to staff were minimised.

There were robust recruitment practices in place and sufficient staff levels to meet people's needs.

The registered manager told us at the time of this inspection staff did not directly administer medicines to anybody as people's relatives took the responsibility for this. Where this was not possible and where people did not manage their own medicines, staff prompted people. The registered manager said all staff received appropriate training to help to ensure people received their medicines safely and staff had clear guidance to follow.

The registered manager ensured that all staff received appropriate training and support to understand and to manage COVID-19. This included best practice for infection control and the use of PPE.

There were systems in place to ensure that accidents, incidents and risks were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of events occurring in the future.

Together with referral information, assessments of need and risk were carried out and these informed people’s support plans which were reviewed and updated as people's needs changed.

People told us they were well supported by staff. They were supported to eat and drink according to their dietary requirements taking into consideration people's preferences.

People told us they were treated with dignity and respect. They told us staff had the right skills to deliver appropriate care and support.

People and their relatives said the registered manager welcomed feedback and they said complaints were dealt with swiftly and professionally. People told us they thought the service was well led and that they were very happy with the support they received.

There were effective systems in place to monitor the quality of the service provided to people which ensured good governance. Technology was used effectively by the provider to ensure people were informed promptly about potentially missed or late calls. The service had systems in place to notify the appropriate authorities where concerns were identified. The culture of the service was positive, open and person centred.

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 good (published 20th November 2019).

Why we inspected

This inspection was prompted because the service had not received a comprehensive inspection since October 2019.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Immaculate Healthcare Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the present time it provides a service for 139 people. Not everyone using the service receives 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, their relatives and the health and social care professionals we spoke with all said they were happy with the service and support being provided to people. Comments included, “I am very satisfied with the care I receive from Immaculate”, “We are so pleased with the care and support offered us by this agency” and “We have had good feedback about the quality of services being provided to people.”

There were appropriate safeguarding processes in place to safeguard people from harm that included a comprehensive risk assessment for people and staff.

There were appropriate numbers of staff to meet people's needs and safe recruitment practices were in place.

The provider had appropriate policies and procedures in place to support people safely with medicines where required.

Since the last inspection the registered manager ensured all staff had relevant health and social care qualifications and completed training to ensure they were able to meet people’s needs effectively. Support was provided appropriately for staff with regards to their professional roles.

People told us they were encouraged to develop their skills and build their confidence, so they could maximise the choices they had in their lives. They said staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Records showed people were supported to have their health needs met, with access to health professionals as required.

The registered manager and staff spoke about people with care and kindness. Assessments and care plans included details of their preferences and wishes for care and support. People told us they were fully involved in the assessment and care planning process.

There was sufficient detail and personalisation in the care plan to ensure the person's needs were met in a personalised way.

The provider had systems in place to ensure concerns and complaints were responded to in an appropriate way.

The provider had systems and processes in place to monitor the quality and safety of the service.

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 9 October 2018). 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.

Why we inspected:

This was a planned inspection in line with our inspection schedule. We found the service met the characteristics of a "Good" rating in all areas.

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.

Immaculate Healthcare Services Ltd Croydon is a service which is registered to provide personal care to adults in their own home. At the time of our inspection there were 190 people using this service.

The registered manager remained 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.

The service was not always well-led because the provider’s auditing process did not consistently or effectively identify issues where the service was not meeting their own quality standards. This meant that the service had not been improved or developed where it needed to be and we have made a recommendation the provider comprehensively reviews their auditing processes.

Some people told us they felt safe with the services they received and other people told us they experienced late or missed calls on occasions that meant their care was not provided as agreed with them. The provider had not regularly assessed staff competencies to administer medicines safely to people they supported.

There was a recruitment process in place for the selection of staff. This included checks with the Disclosure and Barring Service (DBS) to ensure potential employees were suitable to work with vulnerable people. Access to some of the staff file information was difficult and we were only fully enabled to see the correct information when the registered manager was present on the second day of the inspection.

Our inspection found that medicines were managed safely. Records relating to the administration of medicines were accurate and complete. The registered manager told us they were reviewing the process for ‘spot checks’ to ensure staff had the skills and knowledge to prompt medicines safely.

Staff were aware of the provider’s policies and procedures to do with safeguarding people and they knew how to identify and report concerns about potential abuse.

There were appropriate numbers of staff on duty to support people. Most people were supported by a regular staff member or group of staff who they knew. People were provided with the care and support they required by staff who were trained and supported to do so.

Risk assessments for people, their home environment’s and staff were carried out to ensure risks were identified. There were appropriate plans in place to minimise and manage these risks and to keep people and staff safe from injury and harm.

Staff we spoke with were motivated, passionate and enthused about helping people where they needed it.

Staff ensured people consented to the care they received. Staff were aware of how to respect people's choices and rights. People and their relatives were involved in decisions about their care and support. People and their relatives knew how to complain and felt confident their concerns would be addressed.

The provider dealt with complaints in a timely and thorough way. Staff felt confident in their roles and were aware of their responsibilities. Systems were in place to ask people their views about their care.

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 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.

The majority of people using the service and their relatives spoke positively about the care provided by the service and said that they felt safe with care staff. Staff recognised how to identify the signs of potential abuse and knew how to respond appropriately to keep people safe. There were sufficient numbers of trained care staff available to enable the service to deliver care at the times preferred and to provide for any staff absences. The agency office was suitably staffed to coordinate services.

People found that the majority of delays in care staff arriving on time were mainly due to unavoidable factors such as public transport and road works. Office staff were working hard to improve the service delivery by assigning care staff to work in specific geographic areas to reduce travelling time. Staff had recruitment checks to ensure they were suitable for their role; we made recommendations to strengthen recruitment procedures.

Risks to people and the environment they lived in were assessed, and management arrangements were put in place to promote the safety and welfare of people and staff providing the service. The care arrangements and support needs were reviewed regularly to ensure the care delivered remained appropriate for people’s needs. People were supported by staff who understood the risks people could face and knew how to make people feel safe. People were encouraged to be independent and risks were mitigated in the least restrictive way possible.

Most people were supported by a regular staff member or group of staff who they knew. People were provided with the care and support they required by staff who were trained and supported to do so. People who required support to take their medicines received assistance to do so. People who received support with their medicines were satisfied with arrangements but improvement were recommended to ensure people who required full assistance with taking medicines was in line with safe medicine guidance.

Staff ensured people consented to the care they received. Staff were aware of how to respect people's choices and rights. People and their relatives were involved in decisions about their care and support.

People and their relatives knew how to complain and felt confident their concerns would be addressed. The provider dealt with complaints in a timely and thorough way.

People felt the service was well run and the management team approachable. Staff felt confident in their roles and were aware of their responsibilities. Systems were in place to ask people their views about their care. Quality audit processes were in place to monitor the quality of the service provided. There were signs the service was working hard in making improvements. When required action plans were developed to address areas which needed to be improved.

Management arrangements had improved and were becoming more robust. The service cooperated fully in working with external professionals and participated in training to help them develop their skills.