Background to this inspection
Updated
23 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by one Inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service did not have a manager registered with the Care Quality Commission. The previous registered manager left the service in May 2021. The Nominated Individual had taken on responsibility for day to day management of the service until a new manager had been recruited. Registered managers and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or manager would be in the office to support the inspection. Inspection activity started on 7 June 2021 when we visited the office location. On the 8 June 2021 we spoke with staff, people who used the service and relatives.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service and two relatives about their experience of the care provided. We spoke with nine members of staff including care staff, care supervisors, care coordinator. We also spoke with the nominated individual responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included six people’s care records including medication records. We looked at five staff files in relation to recruitment, training and staff supervision. A variety of records relating to the management of the service, including policies and procedures.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two local authority professionals.
Updated
23 July 2021
About the service
Caring Souls Ltd is a domiciliary care service providing personal care to people in their own 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. At the time of this inspection there were 67 people using the service, 64 of these were receiving support with personal care.
People’s experience of using this service and what we found
We identified shortfalls in the management of people’s medicines and a failure to robustly assess the risks to people’s safety and welfare.
People received support from caring staff, but improvement was needed to ensure staff responsible for administering medicines had been assessed as competent to do so.
Staff were aware of some risks to people's safety and wellbeing and acted to minimise these risks. However, risk management plans did not always provide the guidance staff needed to keep people safe from the risk of harm. This included risk management plans for people at risk of falls, skin damage and continence care.
We recommended the provider consider in their assessment of risks to staff and people who use the service from acquiring COVID-19, the advice from the Social Care Working Group of the Scientific Advisory Group for Emergencies (SAGE). This group have advised that an uptake rate of 80% in staff in each service would be needed to provide a minimum level of protection against outbreaks of COVID-19.
People told us there was enough staff to meet their needs. The provider carried out safety checks such as Disclosure and Barring checks [DBS]. However, it was not always evident that gaps in employment history had been explored and references obtained evidenced as from the most recent employer. We recommended the provider take action to explore any gaps in employment, confirm last employer checks obtained, and a record of their findings maintained.
The provider had a quality assurance system which had identified improvement needed in areas such as staff supervision, spot checks on staff performance, care plan reviews, risk management and feedback surveys. Action plans in response demonstrated how the provider planned to improve the service with timescales.
There had been management changes in recent months. This had impacted on staff morale. However, care staff felt things had improved, and told us they felt supported. The provider had made changes and improvements in some areas, such as recruitment of care coordinators to improve oversight of the service. They were keen to make further improvements, taking action to address the issues in relation to risk management, auditing, staff supervision and performance checks.
People were generally satisfied with the service they received. They felt able to raise any concerns and were confident these would be acted on. People and relatives confirmed staff always wore personal protective equipment (PPE).
People were safeguarded from the risk of abuse and staff knew how to raise any issues. The provider worked with other agencies and professionals to meet people's needs.
Rating at last inspection
The last rating for this service was Good (published 1 September 2018).
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
This inspection was prompted by our monitoring data and intelligence which indicated potential risks. In particular, concerns in relation to oversight and management. In response we undertook this focused inspection to review the key questions of safe and well-led only.
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.
The provider took action straightaway in response to our feedback. They sent a further update shortly after the inspection about progress they had made to address the shortfalls identified.
Enforcement
We have identified a breach in relation to safe care and treatment at this inspection. Please see the action we have told the provider to take at the end of this report.
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.
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 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.