Precious Hope and Home Care Ltd

Precious Hope and Home Care Ltd is a domiciliary care agency providing support, including personal care. The service provides support to people living in their own homes in the community. At the time of our inspection there were 163 people receiving personal care.

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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right support: People told us they were safe with the staff who supported them. Staff were recruited to the service safely. 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.

Right care: Care plans did not always contain sufficient information about people's health needs. People's medicines were managed safely. Staff were trained and understood how to support people to stay safe from harm or abuse. Staff worked in partnership with health professionals to ensure people received the right care and support.

Right culture: Audit systems required further improvement. Systems were in place to monitor the quality of the service people received. Most people and their relatives spoke positively about the service and would them. Staff spoke positively about the support they received from the management team.

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 29 July 2022) and there were 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 we found improvements had been made but the provider remained in breach of regulation.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the 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 Precious Hope and Home Care Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to governance systems to monitor 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Precious Hope and Home Care Ltd is a domiciliary care agency which provides care and support to people living in their own homes. At the time of our inspection there were 106 people using the service, of these 95 were receiving personal care. Care Quality Commission (CQC) only inspects where care workers are providing 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

Care plans did not always contain sufficient information about people’s health needs.

The deployment of staff was not always effective at meeting the needs of the people they supported.

Staff did not all have a good understanding of how to keep people safe and not all were up to date in their training of how to keep people safe.

The systems and processes to review care records and oversee the use of medicines was not effective.

We heard from people, their relatives and staff that calls were often delayed or cut short. Systems and processes in place to review call information was not effective as they had not identified these concerns.

People and their relatives gave mixed feedback about the leadership of the service. Some reported successful changes had not been put in place when concerns were identified to the management. Staff gave us positive feedback about the leadership of the service.

People and their relatives told us that people felt safe when receiving care.

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 27 November 2018).

Why we inspected

We received concerns in relation to oversight of staffing. 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.

We have found evidence that the provider needs to make improvements. 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 Precious Hope and Home Care Ltd 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 monitor the service and will take further action if needed.

We identified breaches in relation to safe care and treatment and governance of the service at this inspection.

We sent the provider a warning notice asking them to make changes. When we next return to inspect the service, we will consider what improvements have been made.

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.

Following the last comprehensive inspection in 12 September 2017, where the service was rated as ‘requires Improvement’ for the second inspection, we asked the provider to complete an action plan to show what they would do to improve the key questions about ensuring people’s safety, making sure calls were timely and ensuring an effective quality assurance system was in place. Because of these issues, breaches of regulations were found in Regulation 12, safe care and treatment and Regulation 17, good governance. We received an action plan on 9 October 2017 which described how improvements would be made to systems to produce a quality service to people.

We then undertook an announced focused inspection of Precious Hope and Home Care Ltd on 16 February 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection had been made. We found the provider had made the necessary improvements and rectified breaches of regulations. The service was then rated as ‘good’. At this inspection we found the evidence continued to support the rating of ‘good’.

Staff received safeguarding training so they knew how to recognise the signs and symptoms of abuse and how to report any concerns of abuse.

Staffing arrangements were suitable to keep people safe. 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.

Risk management plans were in place to protect and promote people's safety.

Where the provider took on the responsibility for the management of medicines, staff followed practice guidelines and staff had been trained to assist with people having their medicines.

On-going refresher training was provided to ensure staff were able to provide care and support for people, and staff had been provided with information on people’s health conditions in order to meet their individual needs.

Staff received supervision and appraisal of their performance to provide quality care to people.

Staff supported people to eat and drink sufficient amounts to maintain a varied and balanced diet.

People had been supported to have health appointments to make sure they received continuing treatment to meet their needs.

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.

Staff consistently provided people with respectful and compassionate care.

People had positive relationships with staff and received care to meet their personal preferences.

Timely care had usually been provided to respond to people’s needs.

Care plans contained information for staff on how to respond to people's needs though more detailed information on people’s preferences and lifestyles was needed.

The provider had a complaints procedure in place for when complaints were received and people had received information about how to complain. Complainants did not always receive a written outcome of their complaint.

People told us that they had confidence in the management of the service to provide managerial oversight and leadership. They would recommend the agency to friends and family if personal care was needed.

Issues identified in surveys had not always been followed up. Audits had not always identified issues that did not provide a quality care service.

We undertook an announced inspection of Precious Hope and Home Care Ltd on 16 February 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 20 and 21 July 2017 inspection had been made. The team inspected the service against two of the five questions we ask about services: ‘Is the service Safe?’ and ‘Is the service Well led?’. This is because the service was not meeting some legal requirements in these areas.

At our previous inspection of this service on the 20 and 21 July 2017 we found that recruitment checks were not sufficient to ensure people were protected from the employment of unsuitable, staff, risk assessments to promote people’s safety were not detailed enough, and calls were not delivered at assessed and agreed times. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

We also found that the service had not ensured that people's health and welfare needs were protected and promoted as good governance systems were not comprehensively in place. This was a breach of Regulation 17 HSCA RA Regulations 2014 Good governance.

Following this inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘Is the service safe?’ and ‘Is the service well-led’ to at least ‘Good’. At this inspection we found the provider had followed their action plan and ensured that people were receiving safe care and that good governance systems were in place and effective.

Precious Hope and Home Care Ltd is a domiciliary care service. It provides personal care to adults living in their own homes. At the time of our inspection there were 100 people using the service of which 94 were receiving personal care.

Not everyone using Precious Hope and Home Care Ltd receives the regulated activity. 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.

The service had a registered manager. This 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.

Since we last inspected the provider had improved their recruitment and selection policy to ensure that the staff employed were suitable for the work they were employed to do. They had also improved their quality assurance systems which meant they had an overview of the service and could take action where necessary if improvements were needed.

People told us the staff made them feel safe and they were satisfied with the reliability and timeliness of their calls. All staff were trained in safeguarding and knew what to do if they were concerned about the well-being of any of the people using the service. The service had safeguarding policies and procedures in place and staff followed these.

People had risk assessments in place so staff had the information they needed to keep people safe. Staff told us the risk assessments they worked to provided them with the information they needed to support people safely.

Staff were trained in the safe management of medicines and the registered manager checked they were competent before allowing them to support people with their medicines. Staff were trained in infection control and wore PPE (personal protective equipment) to reduce the risk of the spread of infection or illness. Staff knew how to raise concerns in relation to health and safety and there were systems in place for them to report these. The providers took action to bring about improvements when necessary.

The service had an open culture and focused on valuing people and encouraging them to be independent and fulfilled. Staff gave us examples of how they had supported people to be more independent and get out and about into the local community.

The service was well-led and people and relatives said they were satisfied with the quality of the care provided. Managers and staff listened to people and made changes to the service in line with their wishes. Staff were well-supported by the provider and managers and had opportunities to give their views on how the service could be improved.

The previous inspection in June 2016 has found that the provider was not comprehensively ensuring the service was safe and well led. Although we found improvements with regard to a number of important issues, these breaches had not been fully rectified. We will be closely monitoring the performance of the service and will return to re-inspect the service. If breaches have not been rectified, we will consider taking further action.

A registered manager was in place. 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 and associated Regulations about how the service is run.

Risk assessments were not consistently in place to protect people from risks to their health and welfare. Staff recruitment checks were not always in place to protect people from receiving personal care from unsuitable staff.

Calls to provide care to people were not always at the agreed and assessed times, which meant people safety had not been comprehensively promoted to ensure they received care at the times they needed.

People and relatives we spoke with told us they thought the service ensured that people received safe personal care from staff. Staff had been trained in safeguarding (protecting people from abuse) and staff understood their responsibilities in this area.

We saw that medicines had been, in the main, supplied safely and on time, to protect people’s health needs.

Staff had received training to ensure they had skills and knowledge to meet people's needs.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives. Assessments of people's capacity to make decisions were in place to determine whether they needed extra protections in place.

People and relatives we spoke with all told us that staff were friendly, kind, positive and caring. People told us they had been involved in making decisions about how and what personal care was needed to meet their needs.

Care plans were individual to the people using the service to ensure that their needs were met, though this did not include all relevant information such people’s life history and full details of people's preferences, likes and dislikes.

People and relatives told us they would tell staff or management if they had any concerns, they were confident these would be properly followed up. Most people and relatives were satisfied with how the service was run, though there were concerns about missed and calls not being on time. Staff felt they were supported in their work by the senior management of the service.

Notifications of concern had been reported to us, as legally required, to enable us to consider whether we needed to carry out an early inspection of the service.

Management had not audited the service comprehensively in order to check whether people's needs had been fully met and to take action as needed to ensure people were provided with a quality service.

A registered manager was in place. 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 and associated Regulations about how the service is run.

Most people and their relatives we spoke with said they thought the agency ensured that people received safe personal care. Staff had been trained in safeguarding (protecting people from abuse) and staff understood their responsibilities in this area.

We saw that medicines were supplied safely and on time, to protect people’s health needs.

Staff had training to ensure they had the skills and knowledge to be able to meet people's needs, though more training was needed to ensure all people’s needs could be met.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choice about how they lived their lives.

Staff had awareness of people's health care needs so they were in a position to refer to health care professionals if needed.

Most people and their relatives we spoke with told us that staff were friendly, kind, positive and caring.

People, or their relatives, were involved in making decisions about how personal care was to be provided.

Care plans were individual to the people using the service to ensure that people's individual needs were met though they lacked some information about people's history and lifestyle lacked to ensure that a fully personalised service could be provided to them.

People or their relatives told us they would tell staff or management if they had any concerns and were confident any issues would be properly followed up.

Most people and their relatives were satisfied with how the service was run by the management. Staff felt they were fully supported in their work by management staff.

Management carried out audits and checks to try to ensure the service was meeting people's needs though issues had not always been followed up to ensure people were provided with a quality service.

The service was not ensuring people’s safety in the use of equipment to maintain their health. Risk assessments were in not fully place to protect people from risks to their health and welfare. Staff recruitment checks were not comprehensively in place to protect people from receiving personal care from unsuitable staff. People had not all received personal care at the assessed and agreed times to promote their health.

This evidence constituted a breach of Regulation 12 of the Health & Social Care Act 2008 Regulated Activities Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Part of this inspection was to check whether the provider had made improvements in a number of areas which did not meet the required standard at the last inspection. From reviewing the records and systems in place, speaking with people who used the service and people who worked at the agency, we found that the service now met all the standards we looked at.

People using the service were all very happy with the care they received and spoke highly of the carers who came into their homes. People told us that if they had any issues they had been able to raise these with the management of the service, that they were listened to and that those issues had been effectively resolved. People told us carers treated them with respect, that they made daily records and that they felt they were adequately trained to carry out their duties.

Staff told us they were happy working for the service. One staff member commented: "They have improved quite a lot which is positive." Another member of staff said that they felt supported by the management and that they could go to them with any issues, should they need to. They told us: "They are so friendly. I am so free to talk to them."

People who used the service were all very complimentary about the carers who came into their homes. One person told us, "It's probably the happiest time of the day when the carer comes." Another person said, "I can't fault any of them. I'm very pleased with all of them." People described being treated with respect by people coming into their homes and told us they felt comfortable approaching the management of the service if they had any problems.

Staff working at the service told us that they felt supported by the management and that they had sufficient time for calls and in between them. All of the staff we spoke with felt adequately trained to carry out their roles and felt that staffing numbers were sufficient to meet the needs of the people using the service. One staff member commented that, "Everyone's really supportive. We have a lot of training and we all support each other."

Having spoken to people and reviewed the documentation at the service we found that people were being treated with dignity and respect. However, we found that the service was not keeping adequate records in relation to people's medication and that improvements were needed in terms of how the service was monitoring and assessing the quality of the care being delivered.