ICare (GB) Limited - Runcorn

I Care (GB) Limited Runcorn is a domiciliary care agency providing personal care to adults in their own homes. The service was providing personal care to 26 people 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

Improvements were made to the management of medicines following the implementation of a new electronic system. People told us they received their medicines at the right times.

The provider had improved their systems in relation to risk management. Risks to the health, safety and welfare of people were identified through the completion of risk assessments. Risk assessments provided sufficient information about the risks people faced and how to minimise the risk of harm to people.

Systems and processes to assess and monitor the safety and quality of the service had improved since the last inspection.

People told us there were some inconsistencies in the timing and attendance of their visits. Managers addressed this following our feedback.

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.

Mental capacity assessments were in place. The provider had acted upon a recommendation following the last inspection regarding the application of The Mental Capacity Act 2005 (MCA). Mental capacity assessments were only completed for people who lacked the ability to make decisions for themselves.

The provider maintained a record of completed training required for their role and staff confirmed they had completed this training. Staff received support through regular 1-1 supervision sessions, however, some staff felt support outside of their supervision sessions was inconsistent. Managers addressed this following our feedback.

People and family members told us communication with office staff was in the main good, however, staff felt this could improve for them. Managers addressed this following our feedback.

Staff followed good infection prevention and control practices and they had access to a good supply of PPE which they used and disposed of safely.

The provider operated safe recruitment processes.

The registered manager and provider understood their duty to share information in an open and honest manner. They were receptive of feedback during the inspection and took prompt action to make improvements.

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 August 2022). The service has improved to good.

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 had made the required improvements and was no longer in breach of regulations.

This service has been in Special Measures since 9 August 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

When we last inspected I Care (GB) Limited Runcorn in May and June 2022 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

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 ICare (GB) Limited Runcorn on our website at www.cqc.org.uk.

Follow up

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

I Care (GB) Limited Runcorn is a domiciliary care agency providing personal care to adults in their own homes. The service was supporting 58 people 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 failed to establish effective systems in relation to risk management. Risks to the health, safety and welfare of people were not appropriately identified, managed or mitigated. Risk assessments were either not completed, not person-centred or not detailed enough to guide staff in supporting people safely.

Medicines were not managed safely. Medicines were not being given to people as prescribed. This meant they were at risk of harm.

Systems and processes to assess and monitor the safety and quality of the service were inadequate. The widespread concerns found with risk assessments and unsafe medicines practice were not always picked up by the registered manager's or provider's monitoring processes.

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.

Mental capacity assessments were in place. However, further improvements were needed in the consistency of the application of The Mental Capacity Act 2005 (MCA). For example, MCA’s were completed when there were no concerns about as person’s capacity. We have made a recommendation regarding this.

Most staff were up to date with their mandatory training however, it was difficult for the register manager to effectively monitor this as training records were not well maintained. We received mixed feedback from staff with regards to their ongoing support. We have made a recommendation regarding this.

People and staff told us that communication with office staff was poor. Comments included, “One time I phoned up 15 times and couldn’t get through”.

The service met their safeguarding responsibilities and records showed they shared information with local authorities as required. Feedback we received from the local authority was positive in this area.

Staff followed good infection control practices and used PPE to help prevent the spread of healthcare related infections.

Systems were in place for the safe recruitment of staff. The provider was open about recent staffing challenges and made the decision to reduce their care delivery hours to ensure staffing levels remained safe.

The registered manager and provider understood their duty to share information in an open and honest manner. They approached the inspection process with transparency.

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 2 August 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 regulations.

Why we inspected

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

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 I Care (GB) Limited Runcorn on our website at www.cqc.org.uk.

The provider has been responsive to the concerns found at this inspection and has taken immediate action to ensure the timely improvement in relation to medicines management and governance processes.

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

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 monitor the service and will take further action if needed.

We have identified breaches in relation to risk assessments, medicines management and governance 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

I Care (GB) Limited is a domiciliary care agency providing personal care to adults in their own homes. The service was supporting 80 people 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 service was not well-led. We found significant shortfalls in how the service was managed.

Assurance processes and systems were not robust enough to provide adequate overview and did not always mitigate risk to the health and welfare of people using the service.

Although people told us they were happy with the care being provided, because risk was not appropriately managed, this meant people were sometimes exposed to a risk of harm.

Some people, including those with more complex needs, did not have a care plan in place. What paperwork was in place, did not always reflect their current care and support needs and provided staff with insufficient guidance on how to support people safely.

People told us staff sought their consent, though care records did not always reflect that people had provided consent to their care and treatment or had been involved in the creation of their care plan.

There was ineffective oversight of training for staff. Staff had not completed all mandatory training, including medication and COVID-19 training, to ensure they were competent in their roles. However, some gaps in staff training had been identified by the registered manager and training sessions had been booked.

We have made a recommendation about staff deployment to help ensure more effective covering of calls.

The registered manager began to address our concerns immediately following the inspection, showing they were responsive to making the required improvements, and that the safety and quality of the service was a priority.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

This service was last inspected on 11 February 2018 and rated Good (report published 11 April 2018.)

Why we inspected

The inspection was prompted in part due to concerns received about a lack of care plans, risk assessments and medicines management. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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 has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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 safe care and treatment, consent 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 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 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 younger disabled adults. The service was re-registered by CQC last November due to a change of legal entity. This was the services first inspection under the new provider’s registration.

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 2008 and associated Regulations about how the service is run.

Everyone we spoke with said they felt safe receiving a service from I care.

Staff were able to describe the process they would follow to report actual or potential abuse, this mostly consisted of reporting the abuse to the line manager. The service had a safeguarding policy in place, which we viewed and staff we spoke with told us they were aware of the policy. Safeguarding training took place as part of the induction for new staff, and was refreshed every year. The service reported and acted upon 'care concerns' and demonstrated that they had implemented lessons learned from any issues raised.

Risk assessments were in place and were reviewed often or when people's needs changed. We did highlight at the time of our inspection that some risk assessments would benefit from being more personalised.

Staff recruitment records showed that staff were recruited safely recruited after a series of checks were undertaken on their character and work history.

People were supported with their medication in accordance with their assessed needs.

Staff were supplied with personal protective equipment (PPE). This included gloves, aprons and hand sanitizer. Staff we spoke with told us they were always able to ask for more PPE when needed. Staff had completed infection control and prevention training, and understood the important of reporting outbreaks of flu and vomiting to the registered manager, so they could cover their work so as not to spread the infection.

The registered manager and the staff understood the principles of the Mental Capacity Act 2005 and associated legislation. However, documentation was lacking in some areas with regards to consent and best interests in general. We have made a recommendation about this.

Staff undertook training in accordance with the providers training policy. Staff told us they enjoyed the training.

People were supported as part of their assessed care needs with eating and drinking, and staff documented what people ate and drank to ensure they were getting access to adequate nutrition and hydration.

Staff supported people to access other healthcare professionals such as GP’s and District Nurses if they felt unwell. We saw in most cases family members would do this for their relative; however, staff were able to describe some occurrences when they had to call other medical professionals, such as 111 for advice on someone’s behalf.

We received positive feedback regarding the caring nature of the staff.

People said they were supported to make decisions regarding their care and treatment and they were able to chat with the staff when they came to their homes.

Care plans contained detailed information about people, what their preferences were, and how they liked their routine to be conducted. Information in care plans was regularly reviewed and updated in line with people’s changing needs, which showed that the provider was responsive to people’s needs and preferences. One person did raise that their care plan contained some inaccurate information, however the registered manager evidenced that action had been taken to correct this.

People and their relatives told us their independence was promoted as much as possible in the way that staff gave them choice and control over how they wanted their care delivered.

Complaints were investigated in line with the providers policies and procedures. We saw that complaints had been acknowledged, and information was available for people to enable them to escalate their complaint to independent investigators if they were not happy with the outcome.

Staff and people who used the service spoke positively about the management. Staff felt the service was person centred, and they were encouraged to get to know the people they supported.

A quality assurance system was in place and the manager looked at ways they could continuously improve the service people received. Some issues we highlighted during our inspection, such as the MCA, were not always picked up on using the quality assurance documentation in place. We discussed this as the time of our inspection with the registered manager.

External visits took place from contract monitoring officers the actions plans formed which were shared with us.