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Chenai Holistic Home Care Agency Ltd Inadequate

This service was previously registered at a different address - see old profile

We are carrying out a review of quality at Chenai Holistic Home Care Agency Ltd. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 21 July 2020

During an inspection looking at part of the service

About the service

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

Inspection carried out on 7 January 2020

During a routine inspection

About the service

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,

Inspection carried out on 27 November 2018

During a routine inspection

We carried out an announced inspection of Chenai Holistic Homecare Agency on 27 November 2018. The inspection was partly prompted by concerns received from a local authority. Chenai Holistic Homecare Agency is registered to provide personal care to people in their own homes. The 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, the service provided personal care to 78 people in their homes.

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,

Inspection carried out on 5 April 2017

During a routine inspection

We inspected Chenai Holistic on 5 April 2017. This was an announced inspection. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. Chenai Holistic provides care and support to people in their own homes. At the time of our inspection, the service was caring for approximately 58 people.

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.