Capital Healthcare Management

Capital Healthcare Management is a domiciliary care agency. It currently provides personal care to people living in their own houses and flats in the community. At the time of the inspection there were 32 people using the service.

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.

People's experience of using this service

Risks to people were not assessed or safely managed. Risk management plans were not always in place to guide staff on how to manage these risks safely. People's medicines were not always safely managed.

Staff were not deployed to meet people's needs in a timely manner. Appropriate recruitment checks were not carried out before staff joined the service. Accidents, incidents and complaints were not always recorded and investigated, and learning was not always disseminated to staff.

We had mixed feedback about staff use of Personal protective equipment. (PPE).

Assessments were not always carried out prior to people joining the service to ensure that people's needs could be met and were not used to develop care plans. People’s end of life care wishes were not recorded in their care records.

People and/or their relatives were not involved in planning their care and support, Care plans were not always reviewed and/or updated. People's consent to care and support was not always documented. Feedback sought from people about the service was not documented to help drive improvements. Governance and audit systems were not effective at identifying and reducing risks to people's safety. There was a lack of effective leadership and oversight of the service.

Staff had received adequate training and were supported through regular supervisions. People’s privacy, dignity and independence was promoted. 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.

People told us their consent was obtained prior to staff supporting them. Wherever possible staff supported people to maintain their independence. Staff treated people with respect and maintained their privacy and dignity. People received their support from staff who they knew and described staff as kind and caring.

Rating:

The last rating of the service was Good (published on 16 November 2018)

Why we inspected:

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a comprehensive inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to support and risk management, medicines administration, person-centred care, staffing, safe recruitment, and governance 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Capital Healthcare Management Services on our website at www.cqc.org.uk.

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.

This service is a domiciliary care agency. It currently provides personal care to six people living in their own houses and flats in the community. It provides a service to older adults and people living with physical disabilities. Some people were living with dementia.

Not everyone using Capital Healthcare Services Management Limited receives 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.

There was a registered manager in post. 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.

There were enough staff to keep people safe. People told us and records confirmed that staff were on time and there had been no missed calls to people. Staff were recruited safely. Staff had received the training they needed to provide effective support. They received regular supervision and the registered manager carried out regular spot checks to ensure staff were doing as required when in people’s homes.

Staff knew how to protect people from the risk of abuse. There had been no safeguarding concerns since the service had been operational, but there were policies and procedures in place and the registered manager understood their responsibilities to report any concerns which arose.

Risks relating to people’s care and support, such as mobility or dehydration had been assessed and there was guidance in place for staff regarding how to reduce these risks. There had been one incident relating to people’s care needs, which the registered manager had dealt with appropriately. Staff were aware of how to reduce the chances of this incident occurring again. If there were any other accidents or incidents the registered manager told us they would analyse them to look for trends and patterns. People were protected from the spread of infection. Medicines were managed safely.

People’s needs were assessed before they started using the service. There were accurate care plans in place which gave staff guidance regarding how to support people. People’s cultural and spiritual needs were recorded, and staff respected these. Staff had received training in equality and diversity and told us they would challenge discrimination in any form.

People received the support they needed to eat and drink safely. If people were unwell staff encouraged them or their relative to contact a healthcare professional if needed. Staff worked with other professionals such as district nurses to ensure people received the support they required. No one was currently receiving end of life care, but the registered manager told us they would seek support if needed.

People told us that staff were kind and caring and knew them well. People had been involved in planning their care and support. Staff treated people with dignity and they respected people’s privacy when they were providing personal care. People were encouraged to be as independent as possible.

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. Staff had an understanding regarding the Mental Capacity Act (2005) and told us they always asked for people’s consent before offering support.

There had been no complaints in the past year, but people told us they knew how to complain if needed. The registered manager sought people’s views at regular review meetings, and feedback about the service had been positive. The registered manager planned to send out a survey to gather people’s feedback formally and told us they would analyse the results to look for ways of improving the service.

The registered manager was knowledgeable about their responsibilities regarding providing a domiciliary care agency and completed a range of checks and audits to ensure the service was operating effectively. They understood the need to notify CQC of important events that happened within the service. There was a positive open culture and staff shared the registered manager’s vision of providing a caring service that wanted to expand at a sustainable rate. The service worked in partnership with other organisations, such as the local authority commissioning team, who gave us positive feedback as part of our inspection.