Archived: All Star Care

All Star Care is a service providing care 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 our inspection, the agency was providing care to 11 people, although only seven of those received personal care.

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

Since our last inspection, the provider had failed to introduce governance systems to help ensure that they were providing good quality care to people. There was no auditing in place for medicines records, care plans or care calls. This meant the provider did not have clear management oversight of what was happening in the service and could not be assured that staff were meeting the requirements expected of them. In addition, the provider was unable to evidence staff had received appropriate training and the records held by the provider were in several places meaning it was difficult for the provider to show us evidence of care plans or systems and processes that they had.

Where people had their medicines pre-packed for them by the pharmacy, no records were kept by the agency to demonstrate which care worker dispensed and administered the medicine to the person.

Risks to people had been identified and guidance was in place for staff to help mitigate those risks. Where people had an accident or incident, this was recorded and action taken in response. Furthermore, the provider and staff knew what constituted a safeguarding concern and as such reported these appropriately.

Staff followed good infection control processes and people told us that staff arrived on time on the whole and stayed for the time they were expecting.

People were supported to access healthcare support when needed and where people received help with their food and nutrition, they were happy with this aspect of their care.

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 were asked if they were pleased with the service provided to them by the agency, although the provider did not formally record responses, staff told us they felt valued and supported by the provider and there was good teamwork.

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 September 2019) and there were breaches of regulation. We carried out this inspection to check improvements had been made. At this inspection we found some improvement had been made, however there was still further work to be done and the provider was still in breach of some regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 1 August 2019. Breaches of legal requirements were found.

We undertook this focused inspection to check they had improved and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive 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 remained as 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 All Star Care 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.

service.

People’s experience of using this service:

There was a lack of robust management oversight and monitoring which meant some shortfalls had not been identified. These included a lack of contemporaneous care records and a lack of robust medicines records.

Although people were cared for by staff who had been recruited through a recruitment process, the provider did not ask staff to confirm they were fit to deliver care to people. Staff did not always receive training at the start of their employment or appropriate or ongoing supervision.

People were encouraged to give feedback about their care. People received their care from consistent staff. Staff were kind and caring and treated people with respect. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were enough staff employed to meet the services care commitments. Staff understood their roles in keeping people safe from abuse and felt able to speak up about any concerns they had. Potential risks to people and staff had been assessed, although some people people’s care records required further detail and staff maintained appropriate standards of infection control.

Staff monitored people’s health and reported any concerns they had about people’s wellbeing. Where people had food provided to them by care staff they said they were satisfied with this aspect of their care. Accidents and incidents were recorded and staff learnt from these. The provider planned changes to the service to help ensure staff arrived on time and stayed the full length of time with people. We only received positive feedback about the provider and the agency.

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

At the last inspection the service was rated Requires Improvement. The report of this inspection was published on 4 August 2018.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. We found at this inspection some improvement had been made, however we identified three separate breaches of regulation in safe care, training and supporting staff and governance.

Why we inspected:

This was a planned inspection based on the previous rating where we found a breach of Regulation 19 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 in the employment of staff.

Follow up:

We will continue to monitor intelligence 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.

All Star Care is a domiciliary care agency which provides the regulated activity of ‘personal care’ to people living in their own houses and flats in the community. It provides a service to older adults, people with physical disabilities, people with mental health needs and people living with dementia who reside in Surrey and Sussex. Not everyone using All Star Care receives 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 the inspection the provider was providing services for nine people, which included four people who received personal care. None of the people using the service for personal care received funding from the local authority. One person received continuing health care funding, and other people used direct payments and self-funding arrangements.

There was a registered manager in post at the time of our inspection, who was the proprietor of the company. A registered manager is a person who has registered with CQC 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 registered manager was present during the inspection and is also the proprietor of the service. At the time of the inspection the registered manager was carrying out personal care visits to people who used the service in the mornings and managing the service at other times. This was a temporary arrangement.

People who used the service reported that they felt safe and comfortable with staff. The provider ensured that people received a punctual service from properly trained staff that they knew well. There were sufficient care workers deployed to cover periods of authorised leave and unforeseen circumstances when staff were unable to attend work. However the staff recruitment was not consistently thorough, for example two members of staff had only one reference each and the registered manager’s discussions with staff about any gaps in their employment was not consistently recorded.

There were systems in place to assess risks to people’s safety although one risk assessment did not have sufficient guidance for staff to ensure they effectively promoted the safety of the person. Staff received medicines training and medicine records were checked by the registered manager to ensure that staff correctly adhered to the provider’s medicines policy. People were protected from the risk of infection as staff followed infection control protocols.

Staff were provided with mandatory training and other specific training to meet the needs of people who used the service. This included training to care for people who were frail and at the end stage of their lives. The staff member we spoke with felt well supported by the registered manager, however the registered manager informed us that the frequency of one to one formal supervisions had reduced since she took over some of the daily personal care visits.

People’s needs were assessed before they began using the service and the registered manager encouraged people to contribute to the care planning process. People were asked about their interests, preferences, likes and dislikes, so that staff were equipped to provide care that was tailored to people’s needs. The care plans were kept under review although we noted that one care plan had not been updated to reflect a significant change in a person’s health and wellbeing. People had signed their care plans to demonstrate that they had been consulted about their care. The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and staff understood the principles of the MCA. People confirmed that they were supported by staff to make choices about their care and preferred routines at home.

People told us that staff were kind, caring and friendly. They knew the registered manager well and spoke highly of her approachable manner. Staff supported people in a respectful way and understood the importance of protecting confidential information. People knew how to make a complaint and felt that the registered manager would respond professionally to any complaints.

We received positive comments from people who used the service and the member of staff we spoke with about the supportive and helpful managerial style demonstrated by the registered manager. Although it was evident that she knew people well and sought their views about the quality of the service, we found that the registered manager’s dual responsibilities in terms of managing the service and carrying out personal care visits had impacted on the time needed to rigorously monitor the quality and accuracy of people’s risk assessments and care plans. Additionally dedicated ‘spot checks’ monitoring visits were not taking place at the time of the inspection to enable the registered manager to comprehensively monitor how staff interacted with people and carried out care. We were advised by the registered manager that she was planning to revert to a fully managerial role in the near future. Beneficial links had been formed with local organisations and records showed that the registered manager sought guidance where necessary from health care professionals.

We have issued one breach in relation to the quality of the provider's recruitment practices. You can see what action we asked the provider to take at the back of the full version of the report.