Cynosure Healthcare Services Ltd

Cynosure Health Care Ltd. is a domiciliary care agency providing personal care and support to people in their own homes. 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. At the time of our inspection there were 12 people using the service.

People’s experience of using this service and what we found

Systems and processes to monitor the quality of the service and ensure people’s safety were not effective. Audits undertaken did not provide guidance for their completion. Audits had failed to identify that the provider’s policies and procedures were not always followed and that improvements were needed.

The policy for the safe management of medicines was not followed. Records used to record the medicine people were prescribed and its administration were not completed in full. Decisions made in people’s best interests in relation to their medicine were not fully documented and did not provide clear guidance for staff.

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 required improvement to ensure best interest decisions were supported by clear guidance for staff.

Family members told us staff were kind and caring. They spoke of the positive impact staff had on their relative’s day to day life. A family member told us, “I can hear chuckles and laughing, it is so nice when they [staff] are cooking and are asking what my relative wants for dinner.”

A family member told us how their relative’s cultural needs were met by staff who had learned to prepare culturally appropriate meals. They told us, “Staff are very good. I wish you could see how patient staff are. Staff have learnt how to cook Jamaican food.”

Potential risks were assessed, and people’s care records provided information for staff as to how to reduce risk and provide safe care. People were cared for by staff who had been assessed as to their suitability to provide care, and who had been provided with training to promote safety and meet people’s needs. Staff were aware of their role and responsibilities in reporting concerns about people’s safety and welfare.

Family members spoke positively as to the quality of care provided and good communication between themselves, care staff and office-based staff, which included the management team.

People’s views as to the quality of the service were sought. Staff were supported to undertake their role, which included supervision and by attending staff meetings. The registered manager liaised with other professionals and organisations to share information and improve the service provided.

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 5 March 2019).

Why we inspected

We received concerns in relation to staff recruitment and training. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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

The overall rating for the service has changed from Good to Requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cynosure Health Care Ltd., on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 the management of medicine and the effectiveness of auditing to monitor the quality of the care provided 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 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.

Not everyone using Cynosure Healthcare received the regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, two people were receiving personal care.

This inspection took place on the 3 and 8 January 2019. This was the second comprehensive inspection for the service. The first inspection in 2017 was inspected but not rated because only one person was using the service. At this inspection the service is rated as overall good.

The provider is the registered manager. 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 provider had systems in place to assess the quality of the service provided; however, they also understood these systems were in their infancy and required strengthening to ensure they were effective.

Staff received safeguarding training so they knew how to recognise the signs and symptoms of abuse and how to report any concerns of abuse. Risk management plans were in place to protect and promote people’s safety. The staffing arrangements were suitable to keep people safe. The staff recruitment practices ensured staff were suitable to work with people. Staff followed infection control procedures to reduce the risks of spreading infection or illness.

The provider understood their responsibility to comply with the Accessible Information Standard (AIS), which came into force in August 2016. The AIS is a framework that makes it a legal requirement for all providers to ensure people with a disability or sensory loss can access and understand information they are given.

Staff received induction training when they first started to work at the service. On-going refresher training ensured staff provided care and support for people following current best practice guidance. Staff supervision systems ensured that staff received regular one to one supervision and appraisal of their performance.

Staff supported people to eat and drink sufficient amounts to maintain a varied and balanced diet. Records about people’s health requirements were documented. Staff supported people to access health appointments if required.

People were encouraged to be involved in decisions about their care and support. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care. People had their privacy, dignity and confidentiality maintained at all times. The provider had a complaints procedure in place to manage and respond to complaints.

People had their diverse needs assessed, they had positive relationships with staff and received care in line with best practice meeting people’s personal preferences. Staff consistently provided people with respectful and compassionate care.

The service had a positive ethos and an open culture. The registered manager was a visible role model in the service. People told us that they had confidence in the provider’s ability to provide a consistent service.

'Edinburgh House' (Cynosure Health Care Limited) provides personal care to people who live in their own homes in order for them to maintain their independence.

At the time of our inspection the provider confirmed they were providing personal care to 1 person.

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.

We were unable to rate the agency as there was not sufficient information available to us to fully assess how safe, effective, caring, responsive and well-led the service was.

When we inspected there was a husband and wife team that included the registered manager. Both persons provided ‘hands-on’ care for the person supported in their own home. The registered manager was actively recruiting additional staff. There were appropriate recruitment procedures in place that ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. There was induction training and on-going training to ensure new staff had the skills, knowledge and support they needed to perform their roles. Both persons were up-to-date with their training but new staff had yet to be appointed.

The provider had systems in place to monitor the quality of the service as and when it developed and had a process in place that ensured people could raise any complaints or concerns.