Flexserve UK Limited

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

Flexserve UK Limited is a domiciliary care agency providing personal care and support to people living in their own homes. The service supported mainly older people, people living with dementia and people who had physical disabilities. At the time of the inspection, 34 people were using the service. Not everyone received the regulated activity, 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

Right Support:

Some risks in relation to people's care and welfare were not thoroughly assessed which could have impacted on people’s safety. We discussed this with the registered manager who had started to make changes to improve people’s risk management plans.

We found minor shortcomings around medicines management which the registered manager rectified immediately following the inspection.

Where required, staff supported people to access specialist health and social care support in the community. Staff supported people to play an active role in maintaining their own health and wellbeing.

Staff supported people to make decisions following best practice in decision-making. 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.

Right Care:

People received care and support from a consistent and knowledgeable staff team. However, recruitment practices were not always safe because recruitment checks did not always meet requirements.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies. Staff had training on how to recognise and report abuse.

Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care.

People received kind and compassionate care. Staff understood and responded to people’s individual needs.

Right Culture:

The service evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. However, quality assurance systems were not always effective as they had not identified the issues we found.

People and those important to them were involved in planning their care. Staff valued and acted upon people’s views.

Staff turnover was low, which supported people to receive consistent care from staff who knew them well.

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 27 December 2018).

Why we inspected

This focused inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to the key questions safe, effective and well-led. For the 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 good to 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 Flexserve UK Limited on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to staff recruitment and the governance of the service at this inspection.

We made a recommendation about assessing people’s risks.

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

Flexserve UK Limited 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 adults of all ages, including people with dementia, learning disabilities or autistic spectrum disorder, mental health needs and physical disabilities.

Not everyone using Flexserve UK Limited receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which is 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 the inspection there were 39 people using the service in this respect.

The service had a registered manager. This 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.

At our last inspection of this service, in March 2018, we found four breaches of legal requirements. These were in respect of staff deployment and training, safeguarding people using the service from abuse, notifying CQC of allegations of abuse, and good governance. The service was rated ‘Requires Improvement’ and we served the provider an enforcement warning notice for the staffing breach. The provider sent us an action plan in respect of the breaches. We undertook this inspection to check that the action plan had addressed the breaches. This was also a comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs and well-led.

At this inspection, we found improvements had been made in all our previous areas of concern, and so there were no longer breaches of regulations. This has helped to improve the service’s overall rating to ‘Good.’

The service was now ensuring sufficient numbers of suitable staff were deployed to support people

to stay safe and meet their needs. Reasons for this improvement included better scheduling of staff visits and through ensuring staff visit times were being electronically monitored. Staff visits to people’s homes were therefore more punctual and people’s preferred visit times were being more respected.

The service was now making sure staff had the skills, knowledge and experience to deliver effective care and support. New care staff now completed all parts of a national training program, and established staff received regular refresher training. Staff capability was starting to be practically assessed on key topics, as well as through knowledge tests. Staff were also now receiving regular developmental supervision, support and annual appraisal.

Processes and practices had now been improved to minimise the risk of people being abused and ensure staff responded appropriately if abuse was suspected or reported. The service was also now reporting allegations of abuse to CQC as legally required, which helps with ensuring appropriate regulation of the service.

Governance processes and audits were now effective as they were identifying service delivery shortfalls. The provider was acting on these, to improve on outcomes for people using the service and ensure the service’s sustainability.

However, the rating for ‘Is the service safe?’ remains ‘Requires Improvement.’ This is primarily because where people had more complex needs, assessment of risks was not always comprehensive. Additionally, medicines support plans did not fully reflect the support required for people with highest needs, and administration records were not consistently accurate and comprehensive. The service was taking steps to address these matters.

Most people fed back positively about the service. Some rated it as, “Ten out of ten.” Staff said they would recommend this service to family and friends looking for a care service. We found people were supported by committed staff who built positive working relationships with them. The service ensured that familiar staff were sent to people as much as possible, and that staff treated people with kindness, respect and compassion.

The whole service worked in co-operation with other organisations such as community professionals to deliver effective care and support. This included for supporting people to eat and drink enough, maintain good health and access appropriate healthcare services.

The service enabled people to receive personalised care that was responsive to their needs. They 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.

The views of people and their representatives were listened to, and used to improve service quality.

This was the first inspection of this service at this location. Not everyone using Flexserve UK Limited receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which is help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the start of our inspection there were 56 people using the service in this respect.

The service had a registered manager who had been in post since 2011. This 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.

We found the service was not ensuring sufficient numbers of suitable staff were deployed to support people to stay safe and meet their needs. This was because of occasional missed visits and due to staff sometimes being assigned to attend to two different people at the same time. The service was not ensuring staff followed the visit schedules supplied, but those schedules did not consistently provide staff with enough travel time. People sometimes therefore received shorter visits than planned for.

The service was not making sure staff had the skills, knowledge and experience to deliver effective care and support. Most new staff started but did not complete the provider’s induction process before working with people. Some established staff had not completed relevant training or undertaken timely updates. Training test scores showed some staff could not demonstrate sufficient competency in aspects of their care roles. Staff did not receive regular developmental supervision.

There were a number of ways in which systems, processes and practices were not effectively safeguarding people from abuse. This included insufficient staff training, an incomplete record of all safeguarding cases, failing to embed an action arising from a safeguarding case and shortfalls in assessing the risk presented by information of concern relating to a new staff member.

The service had systems for ensuring the proper and safe use of medicines, but there were inconsistencies with the completeness of records of supporting people to take medicines.

Providers and registered managers must notify CQC about certain changes, events and incidents that affect their service or the people who use it. However, we found four allegations of abuse in connection with the service that were not notified to us. This meant we did not have full oversight of the risks associated with the service.

Governance processes and audits were not consistently effective as they had not identified the concerns and service shortfalls that we found. Office records were not always easily accessible and accurate.

Nonetheless, most people and their relatives said they would recommend the service; none said they would not recommend it. Community professionals reported similar feedback from people. They mostly provided positive feedback about how service worked with them. The majority of staff felt they received good support from the management team.

We found the service treated people with kindness, respect and compassion. People were generally supported by a consistent staff team who knew them well, responded to their needs and preferences, and promoted their independence.

The whole service worked well with other organisations and people’s relatives to deliver effective care and support. This including for supporting people with healthcare matters that were beyond the remit of the care service and for raising welfare concerns such as about the risk of running out of food or heating not working.

The service protected people by the prevention and control of infection and assessed individual risks relating delivery of care. There was good emphasis on supporting people to eat and drink enough and maintain a balanced diet.

People were supported to express their views and make their own decisions about their care and support. These were regularly sought and acted on. The service listened and responded to people’s concerns and complaints, and used this to improve the quality of care.

The service’s rating from this inspection is ‘Requires Improvement.’ We found four breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the 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.