Choose 2 Care

Choose 2 Care Choose is a domiciliary care agency. It provides personal care to people living in their own houses and flats across the Nottinghamshire area. It currently provides a service to nine adults. Not everyone using Choose 2 Care receives a 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.

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

People's care plans were limited in the information provided. Risk assessments did not always include actions for staff to take to reduce the risk of potential harm to people.

The service needed to improve their implementation of the Mental Capacity Act 2005, we found people were not supported to have maximum choice and control of their lives and the staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We found people were safe from the risk of abuse. Safeguarding policies and procedures were being followed correctly by trained staff. Information was shared with the local authority safeguarding team and with us.

Recruitment processes were in place to make sure, that people were protected from staff being employed who were not suitable. Staff had been trained in areas which were deemed as essential by the registered manager.

Quality monitoring systems provided an oversight of the service to demonstrate the service was effectively managed and improving.

Rating at last inspection and update:

The last rating for this service was requires improvement (report published 9 January 2020) and there were multiple breaches of regulation. A warning notice was issued due to the breaches found. The provider completed an action plan following the warning notice to show what they would do to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of the warning notice.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out an announced comprehensive inspection of this service on 19 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in the areas of; ensuring people using the service gave their consent to treatment, safeguarding service users from abuse and improper treatment, ensuring the provider employed fit and proper persons to work with vulnerable adults.

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. 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 remained 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 Choose 2 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.

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

We found people were not always safe. People’s safety had been placed at risk due to safeguarding policies and procedures not being followed. Information was not always shared with the local authority safeguarding team and with us.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff recruitment practices were unsafe and left people at risk of harm.

People’s care plans were limited in the information provided. Risk assessments did not always include actions for staff to take to keep people safe and reduce the risk of harm. Medication was not always given to people as prescribed.

Communication methods did not meet the Accessible Information Standards and did not have regard for people's protected characteristics.

Quality monitoring systems did not provide an oversight of the service or demonstrate the service was effectively managed or improving.

People told us staff were kind and caring and supported them to promote their independence.

People were supported with their meals where needed. People told us that staff attended on time for their calls.

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 28 September 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-Led sections of this full report.

Enforcement

At our last inspection the provider had failed to robustly assess the risks relating to the health safety and welfare of people. At our last inspection the provider had failed to meet Regulation 17 HSCA RA Regulations 2014 Good Governance.

Not enough improvement had been made at this inspection and the provider was still in breach of Regulation 17.

We have identified further breaches in relation to safeguarding people from abuse and improper treatment, staffing and recruitment, the need for consent, and failure to notify CQC of notifiable events at this inspection.

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 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.

There was no requirement for the service to have a registered manager. The provider was the manager and oversaw the day-to-day running of the service. We have referred to the provider as the ‘responsible person’ throughout this report.

At the time of the inspection, eight people received some element of support with their personal care. This is the service’s first inspection under its current registration.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

The risks to people’s safety were not always appropriately assessed. This included how to support people with poor mobility and supporting people to leave their homes in an emergency. The process for the investigation and reviewing of accidents and incidents was not always effective. People felt their medicines were managed appropriately by staff; however, the care planning records and risk assessments in relation to medicines were limited in detail. Staff did not wear company uniforms when supporting people; however, the responsible person ensured they had enough personal protective equipment to reduce the risk of the spread of infection. People felt safe when staff supported them in their homes. There were enough staff to support people and staff were recruited safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not support this practice. Improvements were required to ensure all people’s rights under the Mental Capacity Act (2005) were respected.

We have recommended that the responsible person improve their understanding of the Mental Capacity Act 2005.

People’s care was not always provided in line with current legislation and best practice guidelines. However, people felt staff understood how to support them. Staff were well trained, felt supported and understood people’s needs. Staff performance was not regularly monitored. People were supported with their meals where needed. Other health and social care agencies were involved where further support was needed for people.

People liked the staff and found them to kind and caring. Staff treated people with respect, dignity and compassion. People’s independence was encouraged and people were able to contribute to decisions about their care. Improvements were needed to ensure people’s personal data was secure.

From the records viewed, care plans lacked detail and did not always provide staff with the guidance needed to support people with specific health conditions and their preferences. People felt care staff responded effectively to complaints or concerns raised. People’s diverse needs were discussed with them and respected. There had been limited discussions to ensure that people’s wishes were respected when they neared the end of their life.

Quality assurance processes, including ensuring the assessment of the risks to people’s health and safely were not effective. The risk to people’s health and safety had not been appropriately assessed. The responsible person did not fully understand the requirements of their role to ensure the CQC were informed of notifiable events. The responsible person was well liked and respected by people and their staff.