Winsor Care Services

Winsor Care Services is a domiciliary care service providing personal care to people living in their own homes. The registered manager told us there were 68 people using the service but they were unable to give us the exact number of people receiving the regulated activity of 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. We only reviewed the records of people confirmed to be receiving personal care.

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

We found evidence of repeated breaches of regulations identified at the last inspection and that not enough improvement had been made.

There was lack of management oversight and a lack of reliable systems to inform the management of the quality of care people were receiving. People’s records showed medicine errors and incidents of people missing their medicines occurred. There was evidence people experienced missed, late or much shorter than required care visits. Staff were deployed unsafely and told us, they felt rushed to provide the care people needed.

The provider did not always inform the local authority of safeguarding concerns and did not communicate effectively with health and local authority professionals regarding investigations. The registered manager did not uphold their regulatory responsibility of notifying the CQC of all notifiable incidents when required to do so.

The provider failed to ensure people had risk assessments in place for known risks relating to their conditions and incidents to people occurred as a result of poor risk management. People’s care records did not reflect people’s current needs, choices or preferences.

People and their relatives told us, they experienced the continuity in the staff supporting them. Staff told us, they got to know the people they supported and their preferences. The continuity in rotas meant that the familiarity of staff with people reduced the impact of poor-quality assessments and care plans. People were supported to have choice and control of their lives and staff supported them in the least restrictive way 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 and update

The last rating for this service was requires improvement (published 21 October 2022) and there were 6 breaches of regulations found. 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 the provider remained in breach of regulations.

At our last inspection we recommended that people were involved in the care planning and given a choice of who they wanted to support them and that feedback from people was more consistently collected. At this inspection we found that people were not always involved in their care planning and feedback was not consistently sought from people, despite some improvements.

Why we inspected

The inspection was prompted in part due to concerns about risk management leading to incidents and accidents which had not always been reported to the CQC or local authority. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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 and Recommendations

We have identified breaches in relation to, person centred care, safe care and treatment, safeguarding people from the risk of abuse, duty of candour 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

The overall rating for this service is ‘Inadequate’ and we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

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

We found evidence during our inspection of nine breaches of regulation and the need for this provider to make improvements.

There was a lack of management oversight to ensure good practice. Timekeeping was raised as an issue by many people. Feedback and information of concern received was not always appropriately reviewed to improve the care delivery and/or analysed to prevent similar safety concerns taking place. Staff did not always receive on-going support on the job to ensure they carried out their roles as necessary. People's care plans and risk management plans in place did not always give staff clear guidance on how to mitigate risks. Systems in place did not ensure safe management of people's medicines. The provider's recruitment procedures to check the suitability and fitness of new staff were not effectively applied.

People were not always involved in the care planning and given a choice of who they wanted to support them. Feedback from people was not consistently collected. We have made recommendations about this.

Healthcare professionals told us their communication with the provider was not always effective.

More positively, people felt that staff were caring and that their support needs were met effectively. People's privacy was respected by the staff that supported them.

Staff were aware of the safeguarding procedure and the actions they had to take if they suspected abuse. Infection control and prevention guidance was followed safely and in line with national guidance.

The provider was working within the principles of the Mental Capacity Act (2005) and where needed, appropriate legal authorisations were requested so that people were not deprived of their liberty. Healthcare professionals were involved and provided care to people as necessary. People were supported to access food and drink that met their dietary needs and choices.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 11/05/2021).

At this inspection we found multiple breaches of regulations and the need for this provider to make improvements. Based on the findings at this inspection the overall rating for the service is requires improvement.

Why we inspected

We received information of concern in relation to safeguarding investigations taking place. A decision was made for us to inspect and examine those risks.

Enforcement

We identified nine breaches in relation to person-centred care, safe care and treatment, governance systems, staffing, employment and Duty of Candour. This was because the provider had failed to ensure they always consistently assessed people's care needs related to potential risks and management of medicines. They had not appropriately recruited, monitored and supported staff on the job. The provider did not always operate their established governance systems effectively making sure action was taken to address the repeated incidents and to share information as necessary.

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 the relevant local authorities to monitor progress. We will 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

We found evidence during our inspection of multiple breaches of regulation and the need for this provider to make improvements.

People’s care plans and risk assessments were not consistently completed to provide staff with guidance on the support people required. This meant that people using the service had been placed at unnecessary risk of harm of receiving personal care.

Medicine management procedures were not robust and there was a lack of management oversite to ensure good practice. This meant that people were put at risk to not receiving their medicines as prescribed.

The provider had established governance systems in place to assess and monitor the quality and safety of the care people received however, we found these processes were not always operated effectively. This is because they had failed to pick up a number of issues we identified during our inspection.

The provider’s recruitment procedures to check the suitability and fitness of new staff for their role were not consistently or safely applied. We made a recommendation about this.

The healthcare professionals told us they established good working relationships with the service, some concerns however raised noting that the service possibly was not able to cope with the amount of work because of the rapidly increased number of people they supported.

People and their relatives described staff as friendly, caring and were happy with the support they provided. Staff knew who to report any safeguarding concerns should they witnessed an abuse taking place. A new electronic call monitoring system was introduced to improve staff’s attendance for their shifts. Staff were aware of and followed relevant best practice guidelines regarding infection control and prevention.

The service had grown in numbers since our last inspection and the management structure had been changed to meet the needs of the service. People felt confident to raise their concerns with the managers but told us their calls were not always returned which will be addressed by the registered manager as necessary. Staff told us they had good support and communication from the managers which helped them to meet their job expectations.

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 good (published 09/11/2018).

Why we inspected

We received information of concern in relation to safeguarding investigations taking place. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed all 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 the key questions of Effective, Caring and Responsive were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement because we found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

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 identified two breaches in relation to safe care and governance systems. This was because the provider failed to ensure they always consistently assessed people’s care needs related to potential risks and management of medicines and did not always operate their established governance systems effectively.

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 the relevant local authorities to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our inspection 11 people were receiving support from the service.

There was a registered manager in post at the time of inspection. 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.

Risks to people were effectively managed to ensure that they were kept safe, and reviewed following any changes in need. Staff knew of the action to take to report any potential safeguarding issues. Safe recruitment processes ensured that people were cared for by staff that had been vetted to work with them. Medicines were safely managed and people received their medicines at times that they needed them. Incidents and accidents were sufficiently recorded, investigated and any learning shared.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and sought appropriate consent from people. People’s needs and choices were assessed prior to commencement of the service, and reviewed at appropriate intervals or when their needs changed. People were supported to eat meals of their preference, and seek support from other healthcare professionals.

People and their relatives were enthusiastic about the level of care the service provided. Staff were clear on the needs of the people they were supporting and demonstrated they knew them well. People’s privacy and dignity was respected by the service.

People received personalised care, and their care plans reflected how they preferred for staff to support them. The guidance that was in place demonstrated what people could do for themselves, and how staff should support them to be independent. The service had not received any complaints at the time of the inspection.

The registered manager effectively monitored the quality of the service delivery, and records showed that people were satisfied with the service provision. Management support was highly spoken of, and the registered manager responded to the needs of people, relatives and staff in a timely manner.