Chenai Holistic Home Care Agency Ltd

Chenai Holistic Care Home Care Agency Ltd is a domiciliary care agency providing personal care to people living in their own homes. 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. At the time of our inspection there were 111 people receiving personal care support.

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

The provider’s processes for reviewing the quality and safety of the service were not always effective and systems in place to monitor people’s care visits were not robust. We could not be assured the deployment of staff was appropriate to people’s needs. We have made a recommendation about the provider’s processes for monitoring the deployment of staff. The provider had systems in place to recruit staff safely; however, not all checks were fully documented. Risks to people’s safety were assessed; however, some information lacked personalisation and detail.

People and relatives spoke positively about the staff and management team. Staff understood people’s needs and how they liked to be supported. 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. People and relatives told us staff were kind, caring and respectful in their support.

Staff knew how to report any concerns or signs of abuse. People and relatives told us they had no concerns about safety. Staff had access to appropriate personal protective equipment [PPE] and the provider had ensured there was updated guidance in place to manage any infection control risks. Staff supported people to take their medicine safely and people’s care plans contained information about their medicines support needs.

People and relatives felt involved in the service and the provider sought monthly feedback to ensure people were satisfied with their care. Staff told us they felt supported and were able to contact the management team if they had any queries or concerns. The provider worked in partnership with other health and social care professionals in order to meet people’s support needs and respond to any changes in their health.

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 20 December 2021) and there were breaches of regulation.

At this inspection not enough improvement had been made and the provider was still in breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections

Why we inspected

We carried out an announced inspection of this service on 21 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

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, Caring and Well-led. 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 remained requires improvement.

Enforcement and Recommendations

We have identified a breach in relation to the provider’s oversight and governance processes. 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.

Chenai Holistic Care Home Care Agency Ltd is a service registered to provide personal care to people of all ages living in their own homes. At the time of our inspection they were providing care for 22 people.

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

People and their relatives told us that their calls were sometimes late and they didn’t always know who was turning up. Staff told us there was not enough staff especially drivers.

The provider was not following good practice guidance on testing staff for COVID-19. Staff wore protective personal equipment (PPE), such as aprons, masks and gloves correctly.

Roles and responsibilities of staff were not clear which had led to a breakdown in communication between the registered manager and staff. Improvements were needed in promoting a positive culture with staff.

Oversight and governance systems to assess and monitor the service had suffered as a result of staffing levels. These were being strengthened and quality assurance checks were in progress. The registered manager had learnt lessons and was open and transparent about improving the service as a result.

People and their relatives told us staff cared for them well. They felt safe and the care provided met their needs. Staff completed online training to equip them with skills and knowledge but this did not always prepare them for their role.

Risks to people’s health and wellbeing had been assessed so that staff knew how to support people safely. Safeguarding processes and medicines management systems were in place.

People and relatives were involved in their care and arrangements. The provider worked well with health and social care professionals.

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 24 February 2021)

Why we inspected

We had received concerns in relation to staffing levels and management of the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe 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 has changed from Good to Requires improvement. This is based on the findings at this inspection. We have found a breach in Regulation 12 (Safe care and treatment) and 17 (Good governance).

We have found evidence that improvements are needed. Please see the Safe and Well led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chenai Holistic Home Care Agency 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 to keep people safe and to hold providers to account where it is necessary for us to do so.

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 return to visit as per our methodology and if we receive any concerning information we may inspect sooner.

Chenai Holistic Home Care Agency Ltd provided personal care to 16 people aged 65 and over at the time of the inspection.

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

The people we spoke with during this inspection were positive about the service they received and told us improvements had been made.

People told us they felt safe with the staff who supported them. Staff turned up on time to deliver care and stayed for the duration. Staff had a good supply of Protective Personal Equipment (PPE) and used this effectively when supporting people. Recruitment checks were carried out.

Staff had been trained in a range of mandatory subjects, and new employees were given an induction. People’s needs were assessed prior to care commencing and were supported to eat and drink in line with their assessed needs.

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.

Care plans had been reviewed, and people and staff told us they had been involved in this process. Where appropriate, end of life choices had been recorded. The registered manager had an oversight of the complaints process and provided appropriate and timely responses.

People and staff told us improvements had been made. Governance checks had been put in place, and these were being routinely carried out. These systems and checks needed to be embedded over time to ensure the quality of the service would be maintained.

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, under the previous premises was inspected but not rated, published on (08 September 2020.) 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 we found improvements had been made and the provider was no longer in breach of regulations.

This service has been rated requires improvement for two inspections since it has been registered.

This service has been in Special Measures since 15 May 2020. 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 was a planned inspection based on the previous rating.

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

We carried out an announced comprehensive inspection of this service on 15 May 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve, safe care and treatment, person centred care, staffing and good governance.

We undertook this focused inspection on the 08 September 2020 to check whether the Warning Notice we previously served in relation to Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and if they had followed their action plan and to confirm they now met legal requirements. At this inspection there were still breaches of regulation.

This report only covers our findings in relation to the Key Questions safe, effective, responsive and well led which contain those requirements.

The ratings from the previous 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 inadequate to requires improvement. 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 Chenai Holistic Home Care Agency 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.

Chenai Holistic Home Care Agency Ltd is a domiciliary care agency, providing support with personal care, to 101 people at the time of the inspection.

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

People told us staff were sometimes late and records confirmed this. Medicines were not managed in a safe way because the auditing system for medicine records was not fully implemented. Risk assessments were not person-centred in relation to people’s health conditions and they provided insufficient information to staff about how to support people with health conditions in a safe way. The provider had a system in place for monitoring of safeguarding issues.

Although quality assurance and monitoring systems were in place, these did not always identify and address shortfalls in the service. For example, they failed to address concerns over staff punctuality, lack of medicine audits and poor quality health risk assessments.

Staff undertook an induction training programme before commencing work at the service. Records showed almost all staff training was up to date. However, some people told us not all staff had the necessary skills and knowledge to support them.

Care plans had recently been reviewed and were person centred. They contained detailed information about the individual and how to support them with personal care needs. People had been involved in the review of their care plans. Systems were in place for dealing with complaints. However, some people told us that concerns they had raised had not been fully addressed.

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 (published 15 May 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 enough improvement had not been made, and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check if progress had been made since the previous inspection in relation to Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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, risk assessments, staff punctuality and overall management of the service 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.

The overall rating for this service is ‘Inadequate’ and the service remains 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 act 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.

Chenai Holistic Home Care Agency Ltd is a domiciliary care agency. It provides personal care to people living in their own houses or flats. 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. At the time of the inspection 115 people were receiving personal care from the service.

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

People and their relatives were not always positive about the service. Concerns were raised about staff punctuality and duration of visits, lack of communication from the service and staff approach and training.

The service did not have effective systems in place to monitor or improve the quality and safety of the service provided. There was a lack of oversight by the provider in relation to risks and regulatory requirements.

Risk assessments did not always reflect all possible risks to people using the service to ensure they were safe. Staff were not deployed to ensure people received care at the correct time and by the numbers of staff required to carry out their care safely. The service did not always learn lessons when things went wrong.

Medicines were administered safely however, audits did not identify shortcomings regarding information included on medicine administration charts.

People’s needs and choices were not always assessed to achieve effective outcomes for their care and support. New staff were not inducted effectively and their competency was not appropriately checked before working with people using the service. Staff received refresher training annually and had one-to-one supervision meetings to discuss any concerns. However, some staff did not feel supported in their role.

People were supported with maintaining nutrition and hydration. However, people’s dietary needs were not always detailed in their care plans.

Care plans were not always personalised or detailed and we found inconsistencies with some care plans. People’s communication needs were not always met. The service did not always respond to complaints in a timely manner. We have made a recommendation about including people’s preferences regarding care at the end of their life.

Safe recruitment practices were followed to ensure staff were suitable to support people safely.

People told us they felt safe using the service. Staff knew about safeguarding and whistleblowing. However, we found systems were not in place to ensure people were kept safe from the risk of abuse because the provider did not demonstrate oversight where any form of abuse was suspected.

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 10 January 2019) and there were two 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 not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. However, the inspection was prompted in part due to concerns received about medicines management, poor scheduling and duration of calls, lack of communication with customers, care not provided in line with people’s needs and staff training. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. The provider had not taken effective action to mitigate the risks. Please see the safe, effective, caring, responsive and well led sections of this full report.

Enforcement

We have identified breaches in relation to risk assessments, personalised care, staffing, staff training, safeguarding service users form abuse and improper treatment, receiving and acting on complaints and leadership of the service 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

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 of 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.

At our last inspection on 5 April 2017, we rated the service ‘Good’. At this inspection, we found concerns with care plans, risk assessments, medicine management and quality assurance systems therefore the service has been rated ‘Requires Improvement’.

The service had a 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risks to people were not always robustly managed. We found some care plans did not contain suitable and sufficient risk assessments to effectively manage risks. This placed people at risk of not being supported in a safe way at all times.

Staff had been trained to manage medicines safely. However, we found gaps in some people’s medicine records. We also found that staff were administering medicines without recording this on people’s MAR.

Effective quality assurance systems were not in place. Audits had not identified the shortfalls we found during the inspection.

Accurate and complete records had not been kept to ensure people received high quality care and support.

Care plans were inconsistent as some care plans did not include accurate information and to ensure people received person centred care. People’s ability to communicate were recorded in their care plans.

Although staff had received mandatory training to perform their roles, specialist training in area’s such as catheter care had not been delivered by a qualified person. We made a recommendation in this area.

Staff time-keeping and attendance was being monitored. We noted where staff were late, this was not being pursued by office staff to minimise risk of late calls or missed visits. Staff also raised concerns on the lack of travel time to get to care appointments. We made a recommendation in this area.

We received mixed feedback from staff, relatives and people about the management team. People’s feedback was sought from surveys. However, the surveys were not being analysed to ascertain what the service was doing well in and what area’s required improvement. We made a recommendation in this area.

Staff had been trained on safeguarding. However, not all staff were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally.

Pre-employment checks had been carried out, which ensured staff were suitable and of good character to support people in a safe way.

Pre-assessment forms had been completed to assess people’s needs and their background before they started using the service. However, were there were issues, this had not been followed up during the referral stage.

Regular supervisions were being carried out.

People’s privacy and dignity were respected by staff. People and relatives told us that staff were caring and they had a good relationship with them.

Complaints received had been investigated and relevant action had been taken. Staff were aware of how to manage complaints.

Spot checks of staff supporting people had been carried out to observe staff performance.

We identified two breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to risk management, medicine management and good governance. You can see what action we have asked the provider to take at the back of the full version of this report.

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

The service was safe and had practices in place to protect people from harm. Staff were knowledgeable about safeguarding and what to do if they had any concerns and how to report them.

Risk assessments were thorough and staff knew what to do in an emergency situation.

Staffing levels were meeting the needs of the people who used the service and staff demonstrated that they had the relevant knowledge to support people with their care.

Recruitment practices were safe and records confirmed this.

Medicines were managed and administered safely and audited on a regular basis.

Newly recruited care staff received an induction and shadowed senior members of staff. Training for care staff was provided on a regular basis and updated on a monthly basis. The registered manager had qualifications to train staff and did so on a monthly basis.

Care staff demonstrated an understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis. Consent was recorded in people’s care plans.

People were supported with maintaining a balanced diet and the people who used the service chose their meals and expressed their preferences accordingly.

People were supported to have access to healthcare services and receive on-going support. The service made referrals to healthcare professionals when necessary.

Positive relationships were formed between care staff and the people who used the service and care staff demonstrated how well they knew the people they cared for.

The service supported people to express their views and be actively involved in making decisions about their care. People who used the service told us they felt in control of their care.

The service promoted the independence of the people who used the service.

Care plans were detailed and contained relevant information about people who used the service and their needs. Care plans were reviewed and documented accordingly.

Concerns and complaints were encouraged and listened to and records confirmed this. People who used the service and their relatives told us they knew how to make a complaint.

The registered manager for the service had a good relationship with staff and the people using the service and their relatives. There was open communications between all parties.

The service had effective quality assurance methods in place.