Cure Healthcare Services Limited

Cure Healthcare Services Limited is domiciliary care service that is registered to provide personal care and support to people in their own homes. It provides care to people with dementia, autistic people, people with a learning disability and people with a mental health condition living across Buckinghamshire and Slough. At the time of our inspection there were 7 people using the service.

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

People felt safe from abuse and relatives said they were safe from abuse. Comments included, I am so safe with her (care staff) and I miss her when she leaves” and “I have two people at a time and I am always looked after and safe.”

People were kept safe from avoidable harm because staff knew how to protect them from abuse. The registered manager made sure risk assessments relating to people’s health and welfare were completed and regularly reviewed. There was sufficient staff to support people and safe recruitment practices was employed. Medicine practices were safe because staff received appropriate training and their competency to administer medicines was assessed. There were appropriate infection control practices.

Care and support were planned and delivered in line with current evidence-based guidance, standards, best practice, legislation. Assessment of people’s needs were comprehensive and were developed with involvement of people and their relatives. People’s nutritional needs were met. Staff were appropriately inducted, trained and supported and worked collaboratively with external agencies to ensure people had good health outcomes.

People felt valued by staff who showed genuine interest in their well-being and quality of life. A person commented, “I like them (staff) very much and I like them coming to help me, they are very kind to me.” People were treated with dignity, respect, and kindness. People were supported to express their views and were involved in decisions relating to their care.

People received personalised care to ensure they had choice and control and to meet their needs and preferences. The service was responsive to people’s needs. People said they had no complaints about the service and knew what to do if they needed to. The provider had systems to receive, handle and investigate complaints.

Governance processes¿were effective and helped the service to ensure the welfare and safety were protected and provide good quality care and support. The service has a positive culture that is person-centred, open, and empowering. Staff understood their role and responsibilities, were motivated, and had confidence in the management team. The service worked collaboratively with health and social care professionals to make sure people had access to services of need.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

People were not supported to have maximum choice and control of their lives. Staff had received appropriate training to support autistic people, people with dementia, people with a learning disability and people with a mental health condition. Care plans contained enough information to enable staff to support people and meet their individual needs.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Right Culture:

People and those important to them, including advocates, were involved in planning their care. Staff felt respected, supported and valued. They said the service promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 August 2019) and there was a breach 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.

Why we inspected

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

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

Cure Healthcare Services Limited is registered to provide personal care and support to people 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 the inspection the service supported 38 people across Buckinghamshire and Slough area.

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

People were not always protected from the risk of harm. Staff did not routinely have access to information on how to support people with their medical conditions. People were not always supported by staff who had been recruited safely. People were put at risk due to unsafe recording practice for medicine management.

People did not always have the support they had expected. People told us when they required two staff to support them this was not always provided. Comments from people included, “Two don’t always come and the one is on the phone trying to find a second person,” “The carer had not been informed that [Name of person] had been in hospital and she now needed two people” and “They stay to my satisfaction, but the double ups [two staff] have been a problem.”

People told us they were not routinely supported by a dignified service. People commented they struggled to understand care workers. Comments included “They [Care staff] talk so fast it’s hard, it’s a job to understand” and “They do try and talk to mum, and they smile a lot, but English is a problem.”

People did not have their human rights routinely protected. The service did not routinely support people in line with the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were supported by staff who did not have a regular one to one meeting or an annual appraisal of their performance. No formal system was in place to ensure staff received training when required.

People told us they were not happy about the service received. Complaints to the service were not routinely recorded or fully investigated.

There was a lack of clear management within the service. We found ongoing concerns about record management and quality assurance processes. Audits completed did not drive improvement. Daily records written by care staff were of a poor quality. People told us “There’s no detail about the person in the report it’s just repeated sentences around the jobs they have done” and “The statements are very limited in the book, they don’t have a descriptive English.”

The registered manager did not regularly attend the office, care staff did not meet with the management. We have made a recommendation about this in the report

The service did not learn from when care was not delivered as planned. We found the service did not routinely record actions taken following feedback. We have made a recommendation about this in the report.

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 May 2018) and there was a breach 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 enough, improvement had not been made or sustained and the provider was still in breach of regulations.

This is the second consecutive time the service has been rated requires improvement since it registered with us on 13 February 2017. This is our second inspection of the service.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see all the sections of this full report.

Enforcement

We have identified multiple breaches in relation to safe care, person centred care, staff recruitment and training, compliance with the Mental Capacity Act 2005, the management of complaints, the good governance and management of the service

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.

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

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 requirements in the Health and Social Care Act and associated Regulations about how the service is run.

This is our first inspection of the service since the provider registered with us on 13 February 2017.

People and their relatives spoke positively about the caring nature of staff. A person commented, “I have observed the carer is such a caring person. She is patient, kind and keen to please.” This was observed during our home visits.

People received care and support from staff that had a good understanding of their care and support needs. Staff protected their privacy when personal care was carried out and their dignity was also respected. We found staff were respectful of people’s cultural and spiritual needs. People were able to express their views and be actively involved in making decisions about their care.

The service had recruitment processes in place but these were not always robust. We made a recommendation about checking job application forms. People said they felt safe when receiving care and support from staff. Staff knew how to keep people safe from abuse and had attended the relevant training. Medicines were administered by staff whose competencies were assessed and people were kept safe from infection.

People were supported to have maximum choice and control of their lives. However, the service was not always compliant with Mental Capacity Act 2005 and its codes of practice. We made a recommendation about this.

Staff were not always appropriately supervised. We made a recommendation for the service to seek current guidance on staff supervisions and appraisals. Staff worked within the principles of the Equality Act 2010 to make sure people were not discriminated against. People’s nutritional and healthcare needs were met.

Most of people’s initial assessments made sure plans of care were personalised and based on what people said they wanted. In some instances the service failed to discuss people’s preferences for end of life care. We made a recommendation for the service to review best practice in recording end of life preferences and wishes.

People knew how to raise concerns. We found the service responded to complaints appropriately. We have made a recommendation for the service to ensure its complaint’s policy is available to all people. The service made sure information was given to people with disabilities or sensory impairments in a format that met their communication needs.

People and their relatives felt the service was well-led and staff spoke positively about the support they received from management. People were given the opportunity to express their opinions about different aspects of the service.

Quality assurance systems and processes in place were not regularly monitored for their effectiveness. Therefore, the service was not always able to identify where quality and safety was compromised and the risks to people.

We found a breach in the regulations as a result of this inspection. You can see what action we told the provider to take at the back of the full version of the report.