iCare Solutions Manchester Limited

iCare Solutions Manchester is a domiciliary care service which provides personal care to people in their own houses and flats. At the time of this inspection the service was supporting approximately 40 people. 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

People received care and support from a dedicated, caring and committed team of staff. Staff always sought to ensure people were treated in a dignified and respectful way. Staff understood how to protect people from poor care and abuse and worked well with other agencies to do so. There were enough appropriately trained and skilled staff to meet people’s needs and to keep them safe.

The service benefited from a diverse workforce who were representative of the community it served. The needs of people from different backgrounds were identified, acknowledged, and acted upon.

Systems for audit, quality assurance and questioning of practice had been embedded into everyday practice with clear lines of accountability now established. The provider fully understood the importance of maintaining systems and processes which support good governance.

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.

People and those important to them were involved in planning their care. Staff evaluated the quality of care provided involving the person, their families, and other professionals as appropriate.

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 24 January 2022).

Why we inspected

At the last inspection, 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 safe care and treatment and good governance.

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 of Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

iCare Solutions Manchester is a domiciliary service which provides personal care to people (including children) living in their own houses and flats. The service is operated by ICare Solutions Manchester Limited. At the time of this inspection the service was supporting approximately 47 people. 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 and what we found

At our last inspection of iCare Solutions Manchester in December 2020, concerns were identified regarding staff not staying for the full duration for people’s care visits, staff not using the electronic call monitoring system correctly and unsafe recruitment practices. We found these were still areas of concern at this inspection. In addition, some people raised concerns with us about only one member staff arriving to deliver their care instead of two. Some people also told us staff did not always wear the correct personal protective equipment (PPE).

Improvements to governance systems were required to ensure they were effective at identifying and addressing the concerns found during the inspection. This is the fourth consecutive inspection the service has not achieved an overall rating of good, with repeat concerns identified at each inspection.

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 inadequate (published April 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since April 2021. During this inspection the provider demonstrated that limited improvements had been made. The service is no longer rated as inadequate overall. Therefore, this service is no longer in special measures. The well-led key question remains inadequate however, given the repeated concerns identified and poor regulatory history.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection where the service was rated inadequate and placed into special measures. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

Prior to this inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions (Effective, Caring and Responsive). 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 inadequate to requires improvement. This is based on the findings at this inspection. We found the provider still needs to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for iCare Solutions Manchester on our website at www.cqc.org.uk. You can see what action we have asked the service to take at the end of this report.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

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

ICare Solutions Manchester Limited is a domiciliary care agency. The service provides care and support to older adults living in their own homes in the Trafford, Manchester, Wakefield and Congleton areas.

ICare Solutions Manchester Limited also provides care and support for people referred to the Stabilise and Make Safe (SAMS) service, contracted by Trafford local authority. This service focuses on helping people regain their confidence, strength and independence following an illness, accident or hospital stay.

At the time of this inspection the service was providing care and support to 114 people. 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 and what we found

The registered manager or provider were not able to demonstrate improvements made to the service since the previous inspection. Systems to monitor the quality and safety of the service were either not in place or were ineffective. The provider had not identified the issues we highlighted during the inspection, such as those relating to management and oversight of the service, safe recruitment, timely care planning and use of the electronic call monitoring systems.

There was insufficient provider oversight of the service, including the two satellite hubs in Wakefield and Congleton. The registered manager of the Manchester branch was unable to devote the time needed to the Manchester service as they also assumed a regional role within the wider iCare company. Records we requested in relation to the two satellite hubs of Congleton and Wakefield were not available at the Manchester office. Where action had been taken to try and improve quality and safety of care this did not always accurately reflect the provider’s policies or processes.

The provider monitored staff timeliness through electronic call monitoring. Usage of this by staff was inconsistent across all areas of the business. Where this was used, electronic call monitoring records indicated that some calls were cut short. Where people did not regularly receive their commissioned support in full, we saw no evidence that commissioners were contacted to carry out reviews of care.

Recruitment was not undertaken in a safe way. Staff received pre-employment checks prior to commencing employment, however, these were not always appropriately actioned or followed up. Actions identified to mitigate identified risks were not followed. There was not always a clear rationale documented for why the company judged a potential employee was suitable to work with vulnerable adults when potential risks had been identified.

People were receiving their medicines as prescribed. People felt the staff providing support were competent. The provider had taken action to keep people and staff safe during the COVID-19 pandemic. The provider had shared government guidelines and other information about COVID-19 and staff had access to full personal protective equipment.

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 23 January 2020) and there were three breaches of regulation. At this inspection we found improvements had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6, 8 and 12 November 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 the breaches in person centred care, good governance and the requirement to display the rating.

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 Inadequate. 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 iCare Solutions Manchester Limited 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 good governance, person centred care and recruitment of staff at this inspection. The provider could not demonstrate improvements since the last inspection in good governance and person centred care. For these repeat breaches in regulation we issued two warning notices which were accepted by the provider.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

ICare Solutions Manchester Limited is a large domiciliary care agency. The service provides care and support to primarily older adults living in their own homes in the Trafford and Manchester areas of Greater Manchester. ICare Solutions Manchester Limited also provides care and support for people referred to the Stabilise and Make Safe (SAMS) service, contracted by the local authority. This service focuses on helping people regain their confidence, strength and independence following an illness, accident or hospital stay.

At the time of this inspection the service was providing care and support to 112 people. 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:

The provider monitored staff timeliness through electronic call monitoring, although usage of this by staff was not consistent. Where this was used electronic call monitoring records indicated that many calls were cut short and people did not receive their commissioned support in full. People told us care staff were sometimes late and they were not always informed by the office.

There were processes in place to monitor and audit the safety of the service, although these had not identified some of the issues we found with records and there were inconsistencies with the supervision and appraisal of staff. The provider could evidence actions taken and ‘lessons learned’ when things had gone wrong.

People were receiving their medicines as prescribed. Improvements to assist with the recording and auditing of medicines were being introduced by the provider. People felt the staff providing support were competent. Staff were satisfied with the standard of training they received however, there was a lack of consistency with regards to supervision and appraisal of staff.

Most people were satisfied with the service they received. People were usually supported by consistent teams of staff who knew them and understood their needs and preferences. During our home visits we spoke with people who confirmed their regular staff were kind, respectful and aware of their specific needs. Recruitment processes had improved with a robust risk assessment of potential new employees where this was warranted.

There was information recorded in care plans about people’s social histories and people’s preferences. Care staff told us they would speak to the person and get to know them so that care was person-centred and met people’s needs. People received an annual quality assurance visit and review of their service, and the provider sought feedback about the service. People told us they felt involved in decisions about their care.

The registered manager was supported by a quality assurance officer, office-based care co-ordinators and administration staff. A new manager had been appointed days prior to this inspection with the intention of becoming the registered manager. The current registered manager planned to assume a regional role in the company.

Rating at last inspection:

We last inspected this service on 5 and 7 September 2018, when we rated the service requires improvement. The report was published on 30 November 2018. This is the fourth consecutive time the service has been rated requires improvement.

Why we inspected:

This was a planned comprehensive inspection to follow-up our last inspection when we rated the service requires improvement. Following our last inspection, we asked the provider to complete an action plan telling us how they would become compliant with the three breaches of regulations we identified relating to good governance, person-centred care and requirement as to display of performance assessments.

Enforcement:

We are considering options in relation to enforcement action. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to the end section of reports after any representations and appeals have been concluded.

Follow up:

We identified three breaches of the regulations relating to good governance, person-centred care and requirement as to display of performance assessments. We will request an action plan from the provider to tell us how they plan to address the concerns identified at this inspection and make improvements to ensure the service is rated at least good at future inspections.

We will request that the provider meets with us and commissioners of the service to discuss how they will make improvements. We will continue to monitor the service.

ICare Solutions – Manchester is a domiciliary care service which provides personal care and support to people in their own homes to help them remain independent. They provide other elements of support such as sit-in services, domestic support and welfare checks. The service is managed from an office in Trafford, Greater Manchester with care and support provided for people living in the immediate area and other districts within Greater Manchester, including Stockport, Salford and Irlam. The length of visits for care and support vary depending on the assessed needs of people. At the time of this inspection 321 people were in receipt of a service and the company employed 201 community staff and 11 office staff. However, not everyone using the service receives regulated activity; the Care Quality Commission (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.

At the time of this inspection there was a registered manager in post. 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.

This was the first inspection of this service at this location. Our last inspection of this service had been at a previous address and was carried out in December 2016, where we rated the service overall as Requires Improvement. At the last inspection we identified breaches of Regulation 11 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff did not understand or receive training in the Mental Capacity Act 2005 and the governance of the service required improvement.

The agency had moved to larger premises in August 2017 and had grown the business in size, providing care and support in the four areas of Greater Manchester. The areas of Salford and Stockport were kept separate from the main business of Manchester and Trafford, with each having an assigned care manager or co-ordinator to oversee the day to day basis, with oversight of all from the registered manager.

Recruitment processes were not always safe. Appropriate checks on staff had been undertaken however these checks had not always been carried out before staff began working for the service. Risk assessments completed when Data and Barring (DBS) checks identified staff with any previous convictions were not fit for purpose. Staff using the electronic call monitoring system correctly provided evidence that personal care calls had actually occurred but this was not being used by all staff. Medicines were sometimes stored in a locked tin and accessed only by care staff, therefore people were kept safe from the harmful effects of too many medicines. Staff received training on how to recognise abuse and understood what action was required if they should encounter it.

The registered manager used the interview process to ensure staff had the right skills, knowledge and experience to do the role. Training records showed staff had undertaken training in the Mental Capacity Act 2005 (MCA) and the service understood their responsibilities in how to implement this should someone not have capacity. Care plans reflected contact with health and social care professionals involved in people’s care if any health or support needs changed. People received healthcare support, sometimes as a result of intervention or advice from care staff.

Not all staff were caring and professional in their practice as we saw false recordings in a person’s communication log book. We brought this to the registered manager’s attention so that they could take appropriate action. The service promoted equality and diversity. Company policies and procedures covered the protected characteristics under the Equality Act. Staff were aware of the importance of maintaining and building people’s independence as part of their role.

Support plans were person centred and people confirmed they had been involved in developing these at the start of their care and during any reviews since. There was a good mix of male and female care workers employed and the service could offer clients a choice with regards to the gender of the care worker. The service also tried to allocate staff with shared interests or something in common with the person they were supporting. Staff we spoke with were aware of the complaints policy and informed the office or a line manager if people wanted to make a formal complaint.

There were examples of good practice going on in some areas but these were not replicated across all areas of the business. There was a lack of consistency and the registered manager did not have oversight of all aspects of the business. Each area tended to operate as a stand-a-lone service. Field observation spot checks were carried out to check on staff practice and test staff knowledge about the care and support they provided for individuals. The service linked in with other agencies and worked in partnership with them. Audits of the service had not identified the issues we found with unsafe recruitment practices and false recordings.

At this inspection we identified a new breach in Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to unsafe recruitment practices and a repeated breach of Regulation 17. You can see what action we told the provider to take at the back of the full version of the report.