Sagecare (Lincoln)

Sagecare Lincoln is a domiciliary care service that provides personal care and support for people in their own homes. The service can provide care for adults of all ages and covered Lincoln and surrounding areas. At the start of our inspection there were 181 people using the service, but this was changeable throughout the inspection period.

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

Systems and processes were not always effective in sustaining improvement at the service. Quality assurance systems did not always identify and act on issues and concerns.

The provider monitored care call data which identified continued staffing deployment concerns. There was no action plan in place to address these issues and this directly impacted on people’s care.

Medicines were not always managed safely. We found concerns with how medicines information was recorded.

Risks to people were not always managed effectively. Relevant information was not always recorded by staff and lessons were not always learnt following incidents.

Staff recruitment was not always safe, as work history was not always recorded; however, staff did have other up to date safety checks in place.

People told us some staff did not always wear appropriate person protective equipment (PPE). The provider had taken some action to address staff not wearing PPE.

Staff did not always feel engaged by the provider. Some people and relatives felt the service communicated with them effectively, but others did not.

Some staff were not always aware of provider whistleblowing procedures. Safeguarding systems were in place to protect people and staff knew what signs to looks out for to protect people from abuse. People and relatives told us they felt the service was safe.

The service worked closely with other agencies to support people.

People were supported to have maximum choice and control of their lives and staff supported did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 21 December 2021) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations and remains rated requires improvement. The service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also undertook this inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The overall rating for the service has remained requires improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report. The provider has taken some action to mitigate the risks outlined in this report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sagecare (Lincoln) on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines, risk management and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sagecare Lincoln is a domiciliary care service that provides personal care and support for people in their own homes. The service can provide care for adults of all ages and covered Lincoln and surrounding areas.

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

Systems and processes in place were not always effective in sustaining improvement. The registered manager had failed to inform relevant agencies of significant events.

Medicine management required improvement. We found concerns with the administration of medicines, which placed people at risk of harm.

Safeguarding systems were in place and staff knew how to recognise the signs of abuse. People told us they felt safe. However, systems in place to learn from safeguarding incidents were ineffective.

The provider had a system in place to monitor care call data, however, due to staffing issues people and staff told us there were shortfalls in care delivery, meaning people’s care calls were directly impacted.

People, relatives and staff knew how to complain and who to raise this to. However, some staff and people told us they did not feel listened to or they could not contact the office to raise the concern in the first instance.

Staff and people told us they wore appropriate personal protective equipment (PPE) for the tasks they were completing. Staff took part in regular COVID-19 testing.

People were supported by staff who had been safely recruited and had sufficient training relevant to their role.

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.

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 09 August 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to poor care standards, peoples care needs not being met, poor communication and safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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 remains require improvement. This is based on the findings at this inspection.

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

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 Sagecare Lincoln 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 breaches in relation to medicines, management of safeguarding concerns and service quality oversight at this inspection.

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 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.

Sagecare (Lincoln) provides personal care to younger and older adults living in their own homes some of whom may be living with dementia. The service supported 444 people when we inspected.

Not everyone who used the service received personal care. The Care Quality Commission 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

Overall people were satisfied with the care they received directly from staff. However, they remained unsatisfied with the reliability of the service. They reported that call times were inconsistent, and this caused them upset and distress on occasions. The provider had invested in a new rota system to improve this area. However, the implementation had not been successful.

The provider had invested in a new electronic care plan system which once implemented would support staff to see up to date information to enable them to fulfil their role. This system did not contain all that was required to enable full information about people to be available.

We made a recommendation about the first aid training staff receive to ensure it enables them to respond in an emergency.

The provider’s checks on the service had not highlighted all the issues we found and therefore changes to make improvements had not been instigated.

We spoke with the provider following day two of the inspection and they responded immediately to make improvements and to support the service to implement changes. We could see on day three that the systems had been upgraded and additional support had been provided. This included outlining to staff their roles and responsibilities which will be an important part of the sustainable improvements.

The culture of the team was positive, and staff felt supported and confident. Their approach impacted positively on the support people received because staff placed people and their preferences at the centre of their care. People enjoyed the care they received and had good relationships with the care workers who visited them regularly. Relatives and professionals were fully involved and consulted by staff to ensure people received the care they required. Staff had an excellent knowledge of the people they cared for.

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.

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 7 June 2018) and there were multiple breaches of regulation. 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 a regulation. The service remains rated requires improvement. This service has been rated requires improvement on two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach about how the provider understands quality and safety at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will ask the provider to outline how they will make changes to ensure they improve their rating to at least good. 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.

The service had a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People could not be assured that a sufficient amount of staff were available to support them when needed. Improvements were required to ensure people were supported to take their medicines safely. Risks to people’s safety were not always properly assessed or kept under review to ensure the risk of harm to people was reduced. Further information was needed about people’s specific healthcare conditions so that staff were aware of signs of deterioration and what action they should take. Records showed the required recruitment checks were carried out before staff commenced working at the service. People expressed mixed views on whether staff followed good hygiene practices and the registered manager told us they would keep this under review.

People were supported by staff who had received an induction when they started working for the service. Not all staff had received training updates or recent supervision and the registered manager told us of their plans to address this. People were supported to eat and drink but improvements were required to ensure an effective response to changes in relation to people’s nutritional needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, improvements were required to ensure capacity assessments were carried out when required.

People were supported by kind and caring staff but the service did not ensure that staff had the time to provide compassionate and person centred care. The majority of people told us staff treated them with dignity and respect and these values were kept under review by the management team. People were supported to make choices and told us the regular care staff were aware of and respected their preferences. People had access to independent advocacy.

People felt involved in planning and reviewing their care. People told us they did not always receive care and support at the time it was needed and changes were not communicated to them. People felt able to make a complaint or raise concerns about the service they received. However, some people did not feel these were adequately responded to. The registered manager told us people were supported in line with their wishes at the end of their life.

People and staff told us improvements were required with communication as they were not always informed of changes or were unable to speak to someone when needed. Systems were in place to monitor and improve the quality of the service; however, improvements were required to ensure these were effective. The provider sought people’s feedback in relation to the running of the service and an action plan was in place to address areas that required improvement.

This is the first time the service has been rated Requires Improvement. We found multiple breaches of the legal regulations. You can see what action we told the provider to take at the back of the full version of the report.