Regional Care Peterborough

Regional Care Peterborough is a domiciliary care agency providing personal care to 80 older and younger adults at the time of the inspection.

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

The provider and manager had put new processes and procedures in place to make the necessary improvements in response to the previous inspection. This included regular audits and asking people about the service they were receiving on a regular basis. This piece ofwork was still in progress and not all of the improvements had been embedded and not all of the issues we identified during this inspection had been identified by the provider.

Although improvements had been made, risks to people were not always identified, managed or reviewed to ensure people were safe and protected from harm. Medication administration risk assessments were not in place for all people. Not all staff had completed the necessary medication administration training before carrying out competency assessments for other staff.

Feedback about the service people received was mixed. Some people told us that they or their family members were not always treated in a dignified manner. For example, some people told us that staff sometimes talked to each other in a different language that they did not understand when supporting the person with personal care.

The complaints log did not include information about all complaints and what action had been taken in response.

Care plans were being changed into a new more detailed and person-centred format so that staff had the information they needed. Staff felt supported and spoke highly about the provider and new manager. Staff felt that the training they were provided with ensured they had the skills and knowledge they needed to carry out their roles effectively.

People were mostly 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 inadequate (report published October 2022). 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 the provider remained in breach of some regulations.

This service has been in Special Measures since 26 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from Inadequate to 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.

Enforcement

We have identified breaches in relation to providing safe care, treating people with dignity and respect, responding to complaints and identifying areas for improvement 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.

Regional Care Peterborough is a domiciliary care agency providing personal care to 80 older and younger adults at the time of the inspection. 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’s experiences of the care they received varied. Some people had experienced missed and late calls, and this had put them at risk of not receiving the care and support they needed. Infection, prevention and control measures were not being followed to prevent the spread of infections. We took enforcement action during the inspection and improvements were made. Risk assessments had not always been reviewed to reflect changes and did not include all relevant information for staff to keep people safe. Medicines were not well managed. Staff had not completed medication administration refresher training and had not had their competency assessed by someone trained to do so. The provider's recruitment policy had not been followed when recruiting new staff.

The service was not well led. There was a lack of oversight of the service to ensure that it was being managed safely and in line with current good practice. The registered manager had failed in their responsibility to ensure that the service delivered high quality, safe care to people. The registered manager had not carried out any quality monitoring or audits that may have identified the improvements needed.

People's health and welfare was at risk because procedures and policies to keep them safe were not being followed.

Not all staff had training or competency assessments that had been renewed as required by the providers training policy. Staff had not received regular supervisions or annual appraisals.

Care plans did not include all the information staff needed to be able to support people safely or in the way they wanted. The providers complaints policy had not always been followed when complaints were received.

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.

The last rating for this service was good (published 07 July 2021).

Why we inspected

The inspection was prompted in part due to concerns received about missed care calls. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

During the inspection we served a warning notice regarding the staff not undertaking lateral flow tests in line with the governments COVID-19 Guidance. The provider took immediate action to ensure that staff were following the guidance. The provider has also compiled action plans about the other areas of non-compliance identified during the inspection.

Enforcement

We have identified breaches in relation to people’s safety, management of medicines, quality monitoring, personalised care, missed and late care calls, staff training and competency and complaints. 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Regional Care Peterborough is a domiciliary care agency providing personal care to 80 older and younger adults at the time of the inspection.

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 were happy with the service and the staff that provided their care.

People felt safe using the service because staff knew what they were doing and cared for people in the way people wanted. Staff assessed and reduced risks as much as possible, and equipment was checked to make sure it was safe to use. There were enough staff to support people safely. The provider obtained key recruitment checks before new staff started work.

People received their medicines and staff knew how these should be given. Medicine records were

completed accurately and with enough detail. Staff used protective equipment, such as disposable masks, gloves and aprons to help prevent the spread of infection.

A complaints procedure was in place and people knew who to contact if they were not happy. Staff kept care records up to date but more detail was needed about what people could do for themselves and people’s end of life wishes.

We have made a recommendation for guidance about end of life information.

Staff worked well together, they understood the registered manager's aim to deliver good quality care, which helped people to continue to live as independently as possible. Systems to monitor how well the service was running were carried out. Changes were made where issues had occurred, so that the risk of a similar incident occurring again was reduced. People were asked for their view of the service and action was taken to change any areas they were not happy with.

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 11 February 2020). 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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Regional Care Peterborough is a domiciliary care agency providing personal care to 70 older people and younger adults aged 18 and over at the time of the inspection.

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

There was a lack of managerial oversight at the service and the provider’s monitoring process did not look effectively at systems throughout the service and lessons were not learnt. This led to issues and shortfalls in many areas. Staff recruitment checks were not fully obtained before new staff started working. Staff deployment meant that people did not always receive their care in a timely way. Care plans were not written in enough detail to provide guidance to staff if they did not know the person well. Information about people’s wishes was not recorded, even when it was known.

Risks to people were identified and managed safely and staff knew who to contact if they had concerns that people had experienced harm. There had been some improvement in medicines management, although there was a lack of advice about medicines administered through a patch on people’s skin. Staff used appropriate equipment and clothing to reduce the risk of infection.

People were cared for by staff who had received training needed to care for people. However, this training was not always checked to make sure staff understood the specialised training they had been given. Staff had details if they needed to contact health care professionals and made sure they asked people’s consent before caring for them. People were supported to eat and drink if they needed this.

Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies in the service supported this practice, however records had not been updated to show where best interest decisions had been made.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care. People’s right to privacy was maintained by the actions and care given by staff members.

People were happy that their personal care needs were met and they were happy with the care they received. A complaints system was in place.

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 9 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about missed and late calls to people. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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.

Enforcement

We have identified breaches in relation to staff deployment, staff recruitment checks, planning people’s care, and monitoring the quality and risk of the service, 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 also 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.

This was the first inspection of this service since registration. This inspection took place between 7 and 16 November 2017.

The service had 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 2008 and associated Regulations about how the service is run.

People could not confident they would receive their medicines as prescribed because staff did not always follow the provider’s policy. We have made a recommendation about the management of medicines.

People felt safe receiving their care from this service. Staff had been trained how to safeguard people from avoidable harm and about the potential risks and signs of abuse. There were systems in place to ensure people’s safety was managed effectively. Staff were aware of the actions to take to report their concerns. Records were stored securely.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. There were enough staff available to ensure people’s needs were met safely.

Staff took appropriate actions to protect people from the risk of infection. The management team demonstrated a culture of learning from shortfalls identified by routine audits and other relevant information.

People received care from a staff team who knew them well and understood their needs. Staff were trained and well supported to provide safe and effective care.

People’s nutritional and health needs were effectively met and monitored. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received care and support from staff who were kind and compassionate. People were involved in every day decisions about their care. Staff supported people to express their views and acted on these. Staff provided people with information about their care and other services. Staff treated people with dignity and respect. People’s preferences were taken into consideration.

People’s care and support needs were planned for and evaluated to ensure their current needs and preferences were met. People and their relatives where appropriate, had been involved in developing people's care plans.

People’s care records were detailed and provided staff with sufficient guidance to ensure consistent care to each person that met their individual needs and preferences.

People had access to the service’s comprehensive complaints procedure.

People were supported to receive dignified end of life care.

The registered manager was approachable and people knew who they were. Management systems were in place to check the quality of the service and gain feedback from people, their relatives, staff and other stakeholders. There were a range of checks undertaken routinely to help ensure that the service provided for people was safe. However, these were not always effective. The service worked in partnership with other organisations to ensure people received effective, joined-up care.