9 October 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has experience of using or caring for someone who uses this type of service. The expert by experience telephoned a sample of people and their relatives to check people were happy with their care and support.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced in accordance with our current methodology for the inspection of home care services.
This inspection activity started on 6 and ended on 10 September 2021. We visited the office location on 10 September 2021.
What we did before the inspection
We reviewed the completed Provider Information Record (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR, the last inspection report and also reviewed the information we held about the service. We used all of this information to plan our inspection.
During the inspection
We spoke with the 13 people who used the service, and their relatives, 12 members of care staff, the finance administrator and the provider. In addition. We reviewed a range of records. These included care records, recruitment records, medicine records, staff duty rotas, and quality assurance processes.
After the inspection
We spoke with two healthcare professionals who were positive about the service provided by Proper Care. We continued to seek clarification from the provider to validate evidence found.
9 October 2021
About the service
Proper Care (Cornwall) Limited provides personal care to people living in their own homes in the community. Services are provided to predominantly older people living in and around Helston in south west Cornwall. At the time of our inspection the service was providing support to 70 people. The service generally provides short visits at key times of the day to support people with specific tasks to enable people to continue to live in their own homes.
We carried out this announced inspection between the 6 and 10 September 2021 in response to concerns raised about a drop in staffing levels, the handing back of packages of care to the local authority and the management of the service. At the last inspection, in September 2018, the service was rated good overall. At this inspection we found improvements were required regarding the governance and records held by the service.
People’s experience of using this service and what we found
Several care staff had left the service in the last month. This had led to the provider having to hand back some packages of care to the local authority as they did not have enough staff to carry out the visits. One relative had complained to the Care Quality Commission about this. During the week of this inspection three senior office staff and four further care staff ceased working in the service. The provider was working closely with the local authority to manage packages of care and was actively recruiting to replace staff.
At the last inspection we received mixed feedback from staff, in relation to the amount of time allocated on the rota to travel between care visits. We identified that some staff visit schedules did not include appropriate amounts of travel time. We issued a recommendation in relation to the services visit scheduling systems in the last report. At this inspection we could see that the provider had ensured travel time in some rotas. However, due to the lack of staff recently, many current rotas failed to allocate any travel time between visits. The provider was committed to ensuring staff had sufficient time to travel between visits and assured us this would be added to the rotas as soon as sufficient staff had been recruited.
Any accidents or incidents that occurred had been investigated and action had been taken to help prevent any re-occurrence. However, such events had not always been appropriately recorded.
There were gaps in many medicine records. This meant it was not always possible to establish if people had received their medicines as prescribed.
Audit processes were not effective. For example, medicine records that had been signed off as audited were found to contain gaps where prescribed medicines should have been signed for as given. This had not always been identified and addressed with staff.
The service did not have robust recruitment practices. The provider confirmed that two references were required before staff began working alone. Some staff had commenced working alone in the community without the necessary references required. New staff confirmed they received appropriate training and support before they worked alone with people.
The guidance and process in place for staff to follow when handling people's money for shopping etc., was not robust. This meant it was not always possible to establish how people's money was used.
People and their relatives had not been impacted by the recent staff shortages. They told us the service provided safe care. People told us their care visits were normally provided on time and for the full duration and one person told us, “I feel safe with them. I have not had any cancelled calls. They are very good to me and they stay the time as they should. They wear all the PPE to protect me from Covid-19.”
People told us they received a good service. Some visits had been cancelled recently, due to a lack of staff. People had been advised of this by phone. We spoke to many of these people who confirmed they had access to alternative support and were not wholly dependent on the staff for their support.
Staff had received training in safeguarding adults and knew how to respond if they had any concern in relation to people’s safety.
Risk assessments had been completed and where risks had been identified staff were provided with guidance on how to manage and minimise these risks while providing support.
Staff provided mixed feedback, they told us, “We have had to give some packages back to the Council as we could not cover them. Our rounds are still busy but achievable. My clients have not been affected really,” “Absolutely fine, I really enjoy it, I get good feedback from clients. I have not had any problems” and “We don’t get paid for our travel time between visits, we get paid mileage only. It can be a good bit of our day taken up with travelling between visits.”
Staff told us they were well supported by the provider and commented, “(Provider’s name) is a good boss they are supportive and if we raise an issue with them it gets sorted. I can always get hold of them when I need help with anything” and “I have a lot of respect for (Provider’s name) it has been a good place to work, things are not so great just now but I am confident they will get better.”
Staff knew people they supported well and those people told us they were normally supported by a small group of carers whose company they enjoyed. Information about people’s likes and interests was gathered during the needs assessments process and where possible the service aimed to provide support staff with similar interests.
One person’s relative said, “They have had no cancelled calls at all and my gosh they certainly make her feel safe, they are a Godsend, I don’t know what we would do without them!”
People told us they were asked for their views on the quality of care the services provided as part of the care plans review process and records showed that people’s comments had been complimentary.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The last rating for this service was good (published 9 November 2018)
Why we inspected
We carried out this announced inspection as we had received concerns in relation to the management of the service and staffing shortages. This had led to some packages of care being handed back to the local authority. 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.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.
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 governance processes not being robust and records not always being completed as required. Please see the action we have told the provider to take at the end of this report.
We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Proper Care on our website at www.cqc.org.uk.
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.