Certain Care Ltd

Certain Care Ltd is a domiciliary care agency. It provides personal care to 10 people living in their own homes in the community. Certain Care Ltd supports people with a range of health and social care needs, such as people with a physical disability, sensory impairment or people living with dementia. Support was tailored according to people’s assessed needs within the context of people’s individual preferences and lifestyles to help people to live and maintain independence in their homes. 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

Certain Care Ltd provides a service to people living in the areas of Buckinghamshire and other parts of the country. On the whole, people were happy with their care.

At the last inspection, we found significant risks to people’s safety and identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, enough improvement had been made and the provider was no longer in breach of the Regulations.

The provider had implemented new systems and processes to ensure that staff were routinely tested for COVID-19, and that the appropriate checks were made before staff started work. The provider had implemented new systems and learning around safeguarding people from abuse, to ensure that any potential incidents of abuse were recognised, reported appropriately, and kept people safe. A relative told us, “Not at any point have I felt that [my relative] is unsafe or that anything untoward has happened, not even once.”

At the last inspection, the provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. However, these systems had not ensured the areas of improvement identified at the last inspection had been acted upon and prevented. Subsequently, the provider had recruited further staff to assist with the management of the service. They also engaged with a care consultant to develop and implement new systems of quality monitoring and drive improvement.

We saw that these changes had been implemented and improvements had been made. However, these new systems and processes developed by the provider were not fully in place and needed time to embed and be fully effective.

People’s medicines were managed appropriately, and they told us they were happy with the care they received and their needs were met. One person told us, “They’ve never let me down, someone is always here.” 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; the policies and systems in the service supported this practice.

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 Requires Improvement (published 11 September 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. These actions related to the key questions of Safe and Well-led.

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 remained 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.

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.

Certain Care Ltd is a domiciliary care agency. It provides personal care to 10 people living in their own homes in the community. Certain Care Ltd supports people with a range of health and social care needs, such as people with a physical disability, sensory impairment or people living with dementia. Support was tailored according to people’s assessed needs within the context of people’s individual preferences and lifestyles to help people to live and maintain independence in their homes. 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

Certain Care Ltd provides a service to people living in the areas of Buckinghamshire and other parts of the country. On the whole, people were happy with their care.

We identified significant concerns in respect to people’s safety. The provider had not been carrying out routine testing of staff for COVID-19. Furthermore, systems and processes designed to recruit staff safely, and to identify and act on potential incidents of abuse had not been followed.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. However, these systems had not ensured the areas of improvement identified at this inspection had been acted upon and prevented.

The provider had not notified the Care Quality Commission of specific incidents in line with the requirements of their registration.

Systems were in place for the recording of incidents and accidents. However, we could not see evidence that incidents and accidents were followed up, monitored and analysed over time to recognise any emerging trends and themes, or to identify how improvements to the service could be made.

Feedback from stakeholders was that the provider did not engage effectively with them and we could not be assured that the provider’s responsibilities under of Duty of Candour were being met. The DoC is a regulation that all providers must adhere to. Under the DoC, providers must be open and transparent, and it sets out specific guidelines’ providers must follow if things go wrong with care and treatment.

People told us they were happy with the care they received and their needs were met. People’s medicines were managed appropriately and staff told us they felt supported in their roles and said they liked working at the service.

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; the policies and systems in the service supported this practice.

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 22 May 2018).

Why we inspected

We received concerns in relation to the service not identifying or acting on potential incidents or abuse or harm. 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.

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.

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 infection prevention and control (IPC), systems and processes designed to recruit staff safely, identifying and acting on potential incidents of abuse and systems of quality monitoring and governance.

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.

Certain Care Ltd is a domiciliary care agency. It provides personal care to people living in their own houses in the community and provides a service to adults. On the day of the inspection the service was supporting 25 people with a range of health and social care needs, such as people with a physical disability, sensory impairment or people living with dementia. Support was tailored according to people’s assessed needs within the context of people’s individual preferences and lifestyles to help people to live and maintain independent lives and remain in their homes. Not everyone using Certain Care Ltd 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.

This service was registered by CQC on 2 June 2017, due to a change in the legal entity, however the management and staff remain the same as the previous registration. Certain Care Ltd has not been previously inspected under their current registration.

The service had a registered manager. 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.

Sufficient staff were available to ensure people's wellbeing and safety was protected. A robust recruitment and selection process was also in place. This ensured prospective new staff had the right skills and were suitable to work with people living in the home.

Staff had a good understanding of systems in place to manage medicines. People were supported to receive their medicines safely.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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 were kind and caring and had developed good relationships with people. People told us they were comfortable in the presence of staff. Relatives confirmed the staff were caring and looked after people well. People were provided with the care, support and equipment they needed to stay independent in their homes.

People were provided with information and guidance to access other services which were relevant to them for any on-going support.

People’s individual needs were assessed and detailed care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met.

Staff received regular training and updates to be able to have the right skills and knowledge to meet people’s assessed needs. Staff had regular spot checks, supervisions and appraisals to help them to understand their roles and responsibilities.

Quality assurance and information governance systems were in place to monitor the quality and safety of the service. People and relatives all told us that they were happy with the service provided and the way it was managed.

Further information is in the detailed findings below.