Archived: Right Care (NW) Ltd

Right Care (NW) Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger and older adults with various needs including, people with physical disabilities, sensory impairments, mental health conditions, and dementia. At the time of this inspection 25 people were using the service. Not everyone who used the service received personal care. The Care Quality Commission (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 current manager had not yet registered with CQC but had started the application process. Following the last inspection, the provider recruited the new manager to focus on improvements which needed to be made relating to governance and recruitment; we found these had been implemented. However, some improvements were still needed in relation to the development of risk assessments, auditing and call schedules. We have made a recommendation the provider continues to develop risk assessments for all aspects of people’s care.

People’s care and daily records were recorded on an electronic recording system. Medication records were built into people’s daily records and it was clear when people had received their medicines. However, electronic medication administration records (EMAR’s) had not been built into the system; this was addressed by the provider who contacted the developer of the system to request EMAR’s be implemented. The providers new recording system enabled continued oversight from the management team and helped the provider to respond to things that go wrong, in a timely manner. We have made a recommendation the provider continues to develop their electronic recording system, so it incorporates pharmacy sent EMAR’s.

People felt well cared for by carers and knew who to contact if they had any concerns. The improved organisation and communication had a positive impact on people’s care, and this was evident through their feedback. The provider had robust quality assurance systems in place; however, this was sometimes evidenced in daily audits, rather than an overarching audit record. We have made a recommendation the provider develops audit records, to include a record that evidences the daily quality assurance that is undertaken.

Staff had received regular supervision and support. Important training, such as medication, safeguarding and moving and handling, had been carried out regularly. Staff felt well supported by the management team; however, feedback was mixed on the scheduling of call times and how this had impacted on travel times between calls. We discussed this with the manager following the inspection and they advised this would be reviewed to ensure staff had enough time to travel between calls. We have made a recommendation the provider maintains a realistic amount of time is allocated to care staff for travel.

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 21 September 2020). 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

We carried out an announced inspection of this service on 21 August 2020. Breaches of legal requirements was/ were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance and fit and proper persons employed.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe 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 changed from requires improvement to good. 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 Right Care (NW) Ltd 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.

Right Care (NW) Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger and older adults with various needs including, people with physical disabilities or learning disabilities, sensory impairments, mental health conditions, and dementia. At the time of this inspection 22 people were using the service. Not everyone who used the service received personal care. The Care Quality Commission (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 provider was not following best practice in medicines and the National Institute for Health and Care Excellence (NICE) guidelines were not adhered to. Improvement was required with medication administration records (MARs).

Recruitment checks were not robust to ensure staff were suitable to work with vulnerable adults before being appointed.

Systems in place to manage and record risks were not robust. People’s moving and handling risk assessments were not detailed or were missing. There were no risk management systems in relation to end of life care.

Governance systems were not effective. Audit systems were not robust and there was a lack of quality assurance audits recorded to assess the quality of records. There were no processes in place to improve the quality of care and treatment delivered by the service and feedback from people were not responded to. Governance systems in relation to staff support were not effective. The management of staff rotas was poor.

Staff had received training in safeguarding adults and understood how to recognise signs of abuse. People felt safe receiving support from the staff.

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

Rating at last inspection

The last rating for this service was good (published 25 July 2018).

Why we inspected

We received concerns in relation to the management of the service. 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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.

The provider had started to take action to mitigate the risks identified during the inspection.

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

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 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 the safe recruitment of staff and governance systems at this inspection.

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 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 as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a manager at the service who was in the process of applying to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

People who used the service felt safe with the people who supported them. Staff files showed the recruitment system was robust and people employed had been checked with the Disclosure and Barring Service (DBS) to ensure they were suitable to work with vulnerable people. Staff rotas showed there were enough staff to meet the needs of the people who currently used the service.

Systems were in place to monitor that staff had arrived at a person’s home. This helped to ensure visits were not missed. There were appropriate individual risk assessments within the care plans.

The service had a relevant and up to date safeguarding policy and procedure and all staff had received training in safeguarding. The medicines systems were safe and staff had undertaken appropriate training in medicines administration.

Records showed a thorough induction programme for new staff. New staff shadowed an experienced member of staff until they felt confident in their role.

Further training was on-going and staff were required to complete regular refresher courses for mandatory subjects.

Care plans we reviewed included relevant information about people’s health and well-being. People’s nutritional and hydration needs were clearly documented, along with any allergies and special dietary needs.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People who used the service told us the staff were kind and caring. Staff we spoke with were positive about their jobs and were complimentary about how the service was managed.

We saw from care plans we looked at that independence was promoted and people told us their dignity and privacy were respected. There was a service user guide which included relevant information about the service.

Care files we looked at were person-centred and people’s choices for their care and support were respected.

Risk assessments and care plans were reviewed on a regular basis. Any changes were clearly documented within the care files. Activities, such as accompanying people to go out in to the community were facilitated by the service if possible.

Feedback was sought from people who used the service. Home visits from the manager and quality assurance surveys were completed. There was an up to date complaints policy and procedure and complaints were dealt with appropriately.

The manager had only been in post since February 2018. The manager was experienced and had worked in care settings for several years. People who used the service told us they could contact the management team when they needed to and care staff felt well supported by management.

The manager had commenced staff supervisions and had carried out a staff meeting. We saw records of observations of staff competence which had been undertaken by the manager.

There were many audits carried out on a regular basis. The manager needed to add to the audits any trends or patterns arising and dates of actions when completed.