Archived: Shield Care Ltd

Shield Care Ltd is a domiciliary care service providing personal care to people living in their own homes. At the time of the inspection three people were receiving a service. 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

People and their relatives were satisfied with the service being delivered by the staff. One relative said, “[The staff] are all wonderful. Without them we don’t know how we’d manage. Our [family member] is very lucky.”

People felt safe with the staff. Staff had received training in a wide range of topics and knew how to keep people safe from harm. Assessments of some potential risks had been completed, including for medicines administration. There were no risk assessments related to COVID-19: we have signposted the provider to resources to develop their approach. Infection control procedures were followed by staff and there were enough staff to meet people’s needs.

The service does not have a registered manager in post. Although auditing of various aspects of the service had improved there were still further improvements to be made, especially in the records. Quality assurance processes included seeking the views of people who used the service and their relatives. The provider did not fully understand their legal responsibilities and had failed to display their rating.

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 (report published 18 February 2020), there were multiple breaches of regulation and the service was in Special Measures. We issued the provider with a warning notice stating they must make the improvements by 30 April 2020. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since February 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. The provider had met the requirements of the warning notice and was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We planned to carry out a targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We inspected and found there had been improvements in a number of areas of the service being provided. We widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We did not inspect the other key questions. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Shield Care Ltd on our website at www.cqc.org.uk.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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.

Since the last inspection we recognised that the provider had failed to display their rating. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

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.

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

People’s health and welfare was at risk because procedures and policies to keep them safe were not being followed. Risk assessments had been in place since June 2018 and had not been reviewed to see if any changes were required to keep people safe. Medicines were not well managed. Staff had not completed medication administration training since working for the service and had not had their competency assessed by someone trained to do so. People’s care plans did not have current information about what medication they were prescribed or how they should be administered. Checks of medication administration records had not been recorded and had not identified any issues.

The acting manager was not able to evidence that staff had been safely recruited. The provider’s recruitment policy had not been followed when recruiting new staff. New staff recruited in 2019 had not completed an induction or any training since working for Shield Care Ltd. Staff had not received any formal supervisions or attended any meetings whilst working for the service.

The service was not well led. At the previous inspection we told the provider there was a lack of oversight of the service to ensure that it was being managed safely and the quality was maintained. The provider put procedures in place to make the improvements. However, the procedures had not been followed and action had not been taken to monitor, assess the service or make necessary improvements.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. There were no records that decisions made on behalf of people were made in their best interests by people who had the legal authority to do so. We made a recommendation regarding this.

Care plans did not include detailed information about how people wanted to be supported. People had regular care staff who knew them and had learnt how to support them well. However, there was a risk that any new staff would not know how to meet people's personalised needs.

The feedback we received about the service was very positive. As there were only three staff providing care to the two people using the service they knew them very well.

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 25 January 2019).

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.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to keeping people safe from harm and avoidable risks, management of medication, safe recruitment and monitoring of the service and making improvements where necessary at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

This was the first inspection of this service since it was registered on 12 October 2017. The inspection took place between 11 September 2018 and 11 October 2018. It included visits to the provider’s office on 11 and 19 September 2018. For the first visit we gave the provider 48 hours’ notice as we needed to be sure that there would be someone in the office.

Prior to the inspection The Care Quality Commission (CQC) had received concerns that there were not enough staff to cover the care calls that the agency had arranged with people. At the time of the inspection staff were assisting three people with personal care. This was a total of 19 hours a week.

This service requires a registered manager. A registered manager is a person who has registered with CQC 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 they run the service. There was a registered manager in post. However, they had handed in their notice.

The provider did not have sufficient oversight of the service nor were there adequate systems in place to ensure that people received a high-quality service and were kept safe.

There were not enough staff for people to be sure that their needs would always be met. Staff recruitment was not good enough to ensure that new staff were suitable to work at the service. Not all risks to people had been assessed.

People felt safe and staff had undertaken training to recognise and report any avoidable harm or abuse. Staff gave people their medicines safely and as they had been prescribed. Staff followed the correct procedures to prevent the spread of infection and knew how to report any accidents and incidents.

The registered manager had assessed each person’s needs before they offered the person a service. This was to ensure the service could meet the person’s needs in the way they preferred. Staff had received training and support so that they could do their job well.

Staff supported people to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People had very good relationships with the staff and were very pleased with the service the staff provided. People were involved in planning their care and support. Staff respected people’s privacy and dignity and supported people to remain as independent as possible.

Care plans gave staff detailed guidance relating to the care and support each person needed so that people received personalised care that was responsive to their individual needs. The provider had a complaints process in place but had not received any complaints. Staff cared for people at the end of their lives if the people wanted to stay at home.

Staff felt supported by the registered manager, enjoyed their job and liked working for this service.

You can see what action we told the provider to take at the end of the report.