Archived: Quintessential Support Brokers

Quintessential Support Brokers is a domiciliary care service registered to provide personal care to people in their own homes. At the time of this inspection they were supporting two people with personal care. Not everyone using Quintessential Support Brokers 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.

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

At the last inspection in April 2019 we found there were breaches of seven regulations. At this inspection we found the registered person had taken positive steps and implemented systems to improve the quality and safety of the service provided. The registered person told us they had concentrated on building solid foundations for the business before offering care to new people and increasing the care provision. Our findings demonstrated that the steps taken, and systems put in place were being successful. This meant that the ratings for all five key questions and the overall rating for the service has improved at this inspection. However, some of the systems were very new and we could not improve the ratings to higher than requires improvement in some key questions. This was because not all systems had been in place long enough to evidence consistent good practice over time. The registered person and new manager were clear on improvements that were still needed and had well thought out plans in place to address them. We will check that improvements made have been sustained at our next planned comprehensive inspection.

Staff recruitment had improved, and the registered person introduced a new checking system as a result of some discrepancies identified at this inspection. Improvements to the safety of people meant they were protected from the risks of abuse and relatives felt their family members were safe with the staff providing their support and care. Risks to people’s personal safety had been assessed and plans were in place to minimise those risks. Staffing levels supported people to stay safe while living as independent a life as possible.

The registered person and new manager had introduced new systems for overseeing the quality and safety of the service. The new systems were helping the registered person monitor their compliance with the regulations and registration requirements and identify where they needed to make improvements. We saw at the inspection that the monitoring systems were being adapted and improved as a result of any issues that were not identified by the systems in place. For example, the new manager amended the audit tool for checking staff recruitment was compliant the day after we identified issues with some staff checks at this inspection.

Staff training had been improved and people received effective care and support from staff who knew them well. People received effective health care and support where needed. The handling of medicines had been improved. Staff training, and staff competency checks. had been introduced for all staff handling medicines so that medicines were handled correctly and safely. People's rights to make their own decisions were protected. They 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 benefitted from staff who were happy in their work and felt well managed and supported. People were treated with care and kindness. They were consulted about their care and support and could change how things were done if they wanted to. People were treated with respect and their dignity was upheld. This was confirmed by relatives who provided feedback. Methods to protect personal data had been improved meaning people's right to confidentiality was protected.

A new electronic care planning system had been introduced. The registered person and new manager had re-assessed both people who use the service and recorded in depth information regarding their care needs, preferences and wishes. People received care and support that was personalised to meet their personal care needs and their diverse needs were identified and met. Staff worked well together for the benefit of people and were focused on the needs of the people using the service.

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 25 June 2019) and there were multiple breaches of regulations. At this inspection we found the registered person had made improvements and the provider was no longer in breach of regulations in relation to the service provided to the two people who currently use the service.

This service has been in Special Measures since 24 June 2019. During this inspection the registered person 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.

At the last inspection we identified that the provider had failed to notify us of incidents which were reported to, or investigated by, the police. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Why we inspected

This was a planned inspection based on the previous rating of inadequate. As part of this inspection we also assessed whether the provider had taken the actions necessary to meet the regulation breaches identified at the last inspection.

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.

Quintessential Support Brokers is a domiciliary care service registered to provide personal care to people in their own homes. At the time of this inspection they were supporting two people with personal care. One adult living in the community in their own home and one child, aged between 16 and 18, living in a shared house. Five people in total were being supported to live in the shared house, which is a domestic house, leased to the provider. Not everyone using Quintessential Support Brokers received 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. The local authority funded a 24-hour staff presence in the shared house. The care package for the adult living in the community was based on four personal care calls per day with two staff members allocated to each of the calls.

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

The care and treatment of people was not always appropriate and did not always meet their needs. Care plans did not evidence that people were being involved to the maximum extent possible in their care or that their preferences were always being taken into account.

People were not always protected from the risk of abuse and improper treatment. Risks to people who use the service or staff were not always addressed to reduce or remove identified risks. People were at risk of potential harm because the registered person had failed to ensure the proper and safe management of medicines.

People were at risk of potential harm because the registered person had not ensured the staff providing the care had the qualifications, competence, skills or experience to do so safely. The registered person had not ensured staff were provided with appropriate support, training and supervision as was necessary for them to do their job safely and effectively.

The registered person had not made sure staff employed were of good character and that all required information and checks were carried out. This meant people were potentially at risk of staff being employed to work with them who were not suitable.

The registered person had failed to notify the Care Quality Commission without delay of incidents reported to, or investigated by, the police.

The registered person had not established an effective system to enable them to ensure compliance with their legal obligations and the regulations. They had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided. The lack of robust quality assurance meant people were at risk of receiving poor quality care and, should a decline in standards occur, the provider's systems would potentially not pick up issues effectively.

Whilst the above concerns apply to any person using the service, the person living in their own home in the community was supported to have maximum choice and control of their lives, where possible, and staff supported them in the least restrictive way possible. Their relative was very happy with the support and care provided by the service to their family member. They were very complimentary of the small staff team of regular staff that provided their family member's care and support.

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

Rating at last inspection

At the last inspection the service was rated good (report published 6 January 2018).

Why we inspected

This inspection was prompted by information of concern we received.

Enforcement

We have identified breaches in relation to regulations 9, 12, 13, 17, 18, 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Care provided was not always person-centred; people did not always receive safe care and treatment and were not always protected from the risks of harm or abuse; staff recruitment, training, support and supervision were not adequate to ensure people were safe or that staff were competent and suitable for their roles; effective systems were not in place to ensure the service met the required fundamental standards of care.

We have issued requirement notices relating to the above breaches.

We also identified a breach of regulation 18 of The Care Quality Commission (Registration) Regulations 2009 at this inspection. The registered person had failed to notify us about important events which the service is required to tell us about by law.

We served a fixed penalty notice for this breach.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor intelligence we receive about the service and we will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Special Measures

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 not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For 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.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated regulations about how the service is run.

At our inspection in April 2016 the provider was not operating effective quality assurance systems to assess, monitor and improve the quality and risks related to the service. The provider had not maintained an accurate, complete and contemporaneous record for each person, including a record of the care provided and of decisions taken in relation to the care provided. This was a breach of Regulation 17 of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan detailing the improvements they were going to make to ensure they were meeting the requirements of this regulation.

At this inspection we found the provider had made the necessary improvements to meet the requirements of this regulation. The registered manager had effectively implemented all of the advice and guidance provided by the local authority integrated care team. The registered manager checked the quality of the service daily as they were in day to day control of the service and regularly spoke with people and staff. Since our last inspection the registered manager had implemented systems and processes, which demonstrated how they assured themselves that the service and care people experienced was safe, of good quality and met the regulatory requirements.

The registered manager had systematically reviewed and evaluated people’s care and re-assessed people’s needs to ensure they would promptly identify any changes or potential risks. This meant suitable adjustments had been made to people’s care in a timely manner to ensure their needs were met.

The registered manager had implemented systems to monitor staff knowledge and improve their understanding of their roles and responsibilities. The registered manager completed regular quality assurance visits to conduct staff competency assessments to ensure they effectively applied their learning in practice.

At our inspection in April 2016 healthcare professionals told us people’s care plans did not always accurately reflect their needs. At this inspection care plans we reviewed reflected people’s current support needs. This meant that new staff and agency staff, if deployed, would have all the information they needed to understand people’s risks and know how to provide appropriate support to people.

The registered manager had embedded a proactive approach to anticipating and managing risks to people which was recognised to be the responsibility of all staff. People were protected from the risks of potential abuse by staff who knew what actions to take if they felt people were at risk. Where concerns had been raised, the registered manager engaged with healthcare and safeguarding professionals in an open and transparent manner.

Staff had the right mix of skills to make sure that people experienced safe care. The manager regularly reviewed staffing levels and adapted them to meet people’s changing needs. Staff had undergone pre-employment checks to assess their suitability to provide support to people in their homes.

Staff managed people’s prescribed medicines safely in accordance with relevant national guidance and had their competence to do so regularly assessed. Staff had been trained and understood their role and responsibilities to maintain high standards of cleanliness and hygiene to reduce the risk of infections.

The registered manager had ensured that staff had the skills, knowledge and experience to deliver effective care and support to meet people’s needs. Supervision and appraisal were used to develop and motivate staff, review their practice and focus on their professional development.

The service protected people from the risk of poor nutrition, dehydration and other medical conditions that affected their health. The service had clear systems and processes for referring people to external services, which were applied consistently. Staff made prompt referrals to health professionals when required and acted swiftly on their recommendations.

Staff upheld people’s rights to make sure they had maximum choice and control over their lives, and supported them in the least restrictive way possible.

People were consistently treated with dignity, respect and kindness by staff who made them feel that they mattered. The registered manager ensured staff had the time, information and support they needed to provide care and support in a compassionate and person-centred way.

People were confident that if they complained they would be taken seriously, and their complaint or concern would be explored thoroughly. The registered manager used the learning from complaints and concerns as an opportunity to drive improvement in the quality of the service.

People were sensitively supported to make decisions about their preferences for end of life care. Staff were aware of national good practice guidance and professional guidelines for end of life care.

The registered manager provided clear and direct leadership and had created an open and inclusive culture within the service. The manager had implemented effective governance, management and accountability processes.

Quintessential Support Brokers is a small domiciliary care agency registered to provide personal care to people living in their own homes. At the time of our inspection the service was providing care to six people following their discharge from hospital. The service also provided short term care for people at the end of their life. We undertook an announced inspection of the service on 20 April 2016 and 5 May 2016.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated regulations about how the service is run.

The provider was eager to develop and improve the service and had taken action when concerns had been raised by health and social care professionals and at our first visit. However, the registered manager had not always been pro-active in assuring themselves the service was safe and people received good quality care before concerns were reported. We found the provider did not meet the regulation in relation to good governance. Improvements were needed to ensure the provider would routinely review the service and make the required improvements when shortfalls were identified.

The provider had a staff recruitment process in place to identify applicants who were suitable to work with people. However, the registered manager had not always followed this process through to completion. The registered manager had not ensured all pre-employment information was available to support them to make safe recruitment decisions. At our second visit the registered manager provided us with the required information for all care staff, however sufficient time had not passed for the provider to demonstrate that safe recruitment processes had been sustained.

Relatives and care staff told us people’s risks were understood by care workers and arrangements put in place to keep them safe. However, we found the provider had not systematically reviewed the care people received. Reviews are required to ensure the care provided continues to meet people’s needs and keeps them safe.

People and relatives told us their preferences were met and care workers had a good understanding of people’s care needs, their likes and dislikes. People’s care records however did not always reflect their current needs and the support they required. New care workers would not have all the information they needed to know how to support people effectively.

People and their relatives knew how to complain if they had any concerns about the service. People had received a copy of the provider’s complaints policy. The complaints policy however was not sufficiently comprehensive so people would know what to do if they were not satisfied with the way the provider had managed their complaint.

One person we spoke with and their relatives told us they felt they were safe, cared for and supported by care staff in their own home. They were treated with kindness and respect. They told us the service was reliable, there were sufficient care staff and visits were never missed. They were satisfied with the service they received.

Care staff had received induction training which gave them the basic skills to care for people safely. They told us they felt supported and received regular supervision.

People were supported to eat and drink from care staff who knew what their food preferences were. People and their relatives told us they were involved in decisions about any risks they may take. Systems were in place to protect people from abuse.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.