Topaz Care Services Ltd

Quality Care Solutions is registered to provide personal care to people in their own homes. At the time of our inspection the service was supporting one person with 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 and what we found

The service required a manager who was registered with the CQC. We found not enough progress had been made with recruitment.

Whilst the relative of the person receiving care spoke positively of the level of care and support, we found weaknesses in governance arrangements. There was no effective system in place for case tracking and monitoring care records. Whilst this was related to the size of the service, formal quality monitoring systems needed to be fully developed to ensure the provider had proper oversight of the quality and safety of the service.

There was no effective system of reviewing the recruitment agency’s processes and records to ensure the training and qualifications of agency staff remained up to date. We found agency staff to be knowledgeable but relevant records were kept by the agency and were not accessible locally to satisfy the service that agency staff had appropriate skills and experience of providing care.

There were procedures to ensure the right staff were employed to protect people from harm. However, there were no recruitment plans to ensure the service did not continue to use agency staff to meet normal staffing requirements.

Since our previous inspection, care records were more person centred. They contained meaningful information that identified the abilities and the support required. Likes, dislikes and routine had been recorded. A family member told us their relative’s needs were met.

Care workers told us they felt well supported by the management. They told us that they received appropriate on-going or periodic supervision in their role. In addition, they also received spot checks to monitor their performance when supporting the person receiving 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. A family member of the person receiving care told us their relatives independence was promoted.

There were systems in place to ensure proper and safe use of medicines. A family member of the person receiving care told us their relative received their medicines on time.

Privacy was respected. Care plans described how the person should be supported so that their privacy and dignity were upheld.

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

Rating at last inspection

The service was unrated at the last inspection because of insufficient evidence (11 September 2020).

Why we inspected

We had concerns in relation to how the service was managed. The service was unresponsive to our queries.

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 monitor the service.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation good governance. Please see the action we have told the provider to take at the end of this report.

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.

Quality Care Solutions is registered to provide personal care to people in their own homes. At the time of our inspection the service was supporting one person with 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 and what we found

The person receiving care was at risk of harm because there were no detailed care plans and risk assessments in place. Although this was mitigated by care workers having knowledge of the person’s needs and the person’s relative confirming needs were met, this remained a concern for us.

Recruitment procedures were designed to ensure staff were suitable for the work they would be undertaking. There were sufficient numbers of suitable staff to provide safe care and treatment to the person receiving care. However, there were no realistic and workable plans for managing staffing levels if the COVID -19 pandemic led to shortfalls and emergencies. We signposted the provider to resources to develop their approach.

We judged the service did not have effective quality assurance procedures to ensure the manager had a clear overview of service performance. There was a lack of formal mechanisms to monitor care. Although we found no evidence that people had been harmed, systems were either not in place or robust enough to demonstrate safety was effectively managed. This gave rise to our concerns, particularly if there were to be an increase in the numbers of people receiving care. However, our concerns were reduced due to the decision made by the service to temporarily cease providing care to new people until improvements were made.

Rating at last inspection

The service was unrated at the last inspection because of insufficient evidence (published 11 December 2018).

Why we inspected

We had concerns in relation to how the service was managed. The service was unresponsive to our queries. 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. Therefore, ratings will only be assigned to key questions of safe and well-led only. Furthermore, the overall rating will remain unrated because do not have sufficient evidence to do so.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 safe care and treatment and governance.

Please see the action we have told the provider to take at the end of this report.

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 return to visit this service at a later date to check compliance.

Due to the number of people supported by the service we were not be able to award a rating because we did not have enough evidence.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

There were systems and processes in place to minimise risks to the person receiving care. We were reassured by relatives’ feedback that the person receiving care was safe. The service had safeguarding systems and processes to support care workers to protect the person from avoidable harm. Care workers were aware of how to raise concerns. They had undergone appropriate recruitment checks prior to working at the service. There was an adequate number of care workers deployed to meet the person’s needs. However, the service required more care workers to cover for emergencies. The service was actively recruiting for more care workers. The person received help with medicines. They were supported to take their medicines by care workers who had been trained in doing so.

The person’s relative commented on how well the person’s individual needs were met. The person had a care plan that described the type of support required and how this was delivered. The service worked alongside other professionals, including social workers and GPs. The person’s capacity to make choices had been considered in line with the Mental Capacity Act 2005 (MCA). We saw evidence from the person’s care records that care workers asked for permission before attending to the person’s needs. Care workers were supported to have the skills and knowledge to carry out their role. Care workers had received regular training and support.

Feedback from relatives showed the person was treated with respect. Their privacy was maintained. The person’s individual preferences were respected. Care workers had a good understanding of protecting and respecting the person’s human rights. They were aware of the importance of respecting the person’s values, beliefs and cultures.

The person received person centred care. They had been involved when their care plans were written. By involving the person, the service could deliver care that met their preferences. We discussed with the registered manager that the person’s care plan could be more detailed. There was a complaints procedure in place. Following our inspection, the registered manager told us they had commenced work to comply with the requirements of Accessible Information Standards.

Whilst audits had not been completed, there was a policy in place and a plan to complete audits once the service had more on-going activity. Due to the size of the service, we found the registered manager and the care worker to be well-informed on on-going improvements required. However, quality monitoring systems needed to be fully developed to ensure the registered manager had proper oversight of the quality and safety of the care agency.