Archived: Infinite Care

Infinite Care is a provider of community home care services. At the time of the inspection it was providing personal care to 23 people aged 65 and over. 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 told us they felt they felt safe. However, we found significant concerns in safety and the management of the service which demonstrated people were not receiving safe care.

Information about risks in people’s care plans was not always effective and placed people at risk of harm. Written information detailing how people should be supported safely was not completed or had important missing information. The provider failed to protect people from abuse and to take action when abuse was suspected.

People were at risk of harm due to poor medicines management. There was a lack of information to ensure staff understood when to give medicines which were prescribed ‘as and when required’. We could not be sure people received their medicines safely, as prescribed or by staff that had been sufficiently trained to do so.

Staff had not always received training to equip them to support people, understand their individual needs and mitigate associated risks.

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; the policies and systems in the service did not support this practice. Due to the quality of the care records we could not be assured care had been provided in line with peoples assessed needs, wishes and choices.

The service was not well led. There was a lack of provider oversight and quality monitoring to identify and address risks to people. Auditing was not robust where concerns were raised at previous inspections. The provider failed to take action to sustain improvements.

The registered manager did not have enough autonomy and oversight of the service to ensure that it was being managed safely and quality care was provided.

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 11 November 2020) and there were breaches of regulation for failing to assess and mitigate risks to people, failing to work within the principles of the mental capacity act, failing to have effective systems in place to assess and monitor and failing to improve the safety of the service. The provider completed an action plan after the last inspection to show what they would do to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider update their infection control policy, improve systems to gain feedback from people using the service, improve recruitment processes and improve staff support with supervisions and training. At this inspection we found the provider had not sufficiently acted on these recommendations.

The service is now rated inadequate. This service has been rated inadequate or requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by concerns we received about a safeguarding incident. A decision was made for us to carry out a focussed inspection and examine this incident, check if the provider had followed their action plan from the last inspection and to confirm if they now met legal requirements. As a result, we reviewed the key questions of safe, effective and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found evidence during this inspection that people were at risk of harm and the provider needed to make improvements in all areas inspected. Please see the safe, effective and well led sections of this full report. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Infinite Care on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, consent, safeguarding, person centred care, staff support, training and good governance at this inspection.

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.

Since the last inspection we recognised the provider had failed to notify us of all significant events. 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 worked alongside the provider and local authority to monitor progress. We continued to monitor information we received about the service.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service was therefore placed in ‘special measures’. We took action to cancel the provider’s registration through our enforcement process. This meant we have taken action to prevent the provider from operating this service. This has lead to cancellation of their registration.

Infinite Care is a provider of community home care services providing personal care to 42 people aged 65 and over at the time of the inspection. 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

The provider did not always have effective governance systems in place to monitor the service and drive the necessary improvement. There was a lack of detailed records regarding care records and recruitment management. Quality assurance systems had not always been effective in identifying the concerns we found at this inspection or fully addressed concerns from our last inspection.

People were not always 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; the policies and systems in the service did not support this practice.

The provider had not always ensured safe recruitment practices were taking place. Gaps in candidate's employment history had not been identified or followed up. This meant the provider was not always able to consider whether the applicant's background impacted on their suitability to work with people. We made a recommendation about this.

Systems were in place to seek feedback from people, their relatives and staff. However, these were not always effective. We have made a recommendation about this.

The staff we spoke to did not always feel well supported through training and supervision. We have made a recommendation about this.

The provider had not updated their infection control policy to reflect current guidance in relation to Covid-19. We have made a recommendation about this.

Staff had good access to personal protective equipment (PPE) and understood the current guidance in relation to wearing PPE.

People and their relatives felt there was enough staff for people to be safely supported. However, some people were concerned that the level of care and support declined when they did not have their regular carers.

Staff in the service worked well with each other and external professionals to ensure good health outcomes for people. People were supported to prepare food and drinks that met their needs and preferences.

Regular team meetings took place for staff. Staff who supported people regularly were knowledgeable about them and their needs.

People's preferences and choices regarding protected characteristics had been explored with people in line with The Equality Act 2010.

The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality 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 and update

The last rating for this service was requires improvement (published 3 December 2019). There was one breach of regulation in relation to regulation 12, Safe Care and Treatment, specifically around proper and safe management of medicines. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Infinite Care on our website at www.cqc.org.uk.

At this inspection we found enough improvement had not been made and the provider was still in breach of regulation 12. We also found two new breaches of regulations in relation to consent and governance. The last rating for this service was requires improvement (published 3 December 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

We will describe what we will do about the repeat requires improvement rating in the follow up section below.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now

met legal requirements. This report only covers our findings in relation to the Safe, Effective and Well-led

domains.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as 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, effective and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Infinite Care on our website at www.cqc.org.uk.

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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, consent and good governance at this inspection. We previously imposed a condition in relation to safe care and treatment on the providers registration, requiring them to take monthly action to make the improvements needed and ensure this regulation is met. The Commission considered this condition remained appropriate.

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

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

Infinite Care is a provider of community home care services providing personal care to 24 people aged 65 and over at the time of the inspection. 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

There has not been a registered manager in post since 3 May 2018. There had been a manager in post who had applied to become the registered manager however, they left prior to being registered. The deputy manager was overseeing the management of the service.

People were not always supported to identify their end of life care choices and wishes. Staff had not received end of life training.

There was no evidence that people’s preferences and choices regarding protected characteristics had been explored with people in line with The Equalities Act. We have made a recommendation about this.

The provider did not always have effective governance systems in place to monitor the service and drive the necessary improvement. At times, there was a lack of detailed records regarding medicines and recruitment management.

Medicines were not managed effectively. There were no clear, person centred protocols in place for staff to manage “as required” medicines effectively.

People were not always 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; the policies and systems in the service did not support this practice.

The provider had not always ensured safe recruitment practices were taking place. Gaps in candidate’s employment history had not been identified or followed up. This meant the provider was not always able to consider whether the applicant's background impacted on their suitability to work with people.

The provider had not displayed their ratings in the office or on their website. It is a requirement of Regulation 20A of the Health and Social Care Act 2008 to show the most recent rating on the providers website and at the providers principle place of business.

Staff were supported with regular effective supervision and regular team meetings took place. Staff were knowledgeable about people and their needs.

There were effective systems in place to seek feedback from people, their relatives and staff.

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 (published 21 May 2019). Following this inspection, we used our enforcement powers to impose positive conditions on the providers registration. This means they send us a monthly action plan detailing how they are going to progress and improve. At this inspection we found improvements had been made however, the provider remained in breach of one regulation. The service has been in special measures since 21 May 2019. 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 however the positive conditions remain in place.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Infinite Care on our website at www.cqc.org.uk.

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.

Infinite Care is a provider of community home care services. It provides personal care to people living in their own houses and flats in the community. It provides a service to younger and older adults. At the time of the inspection they were providing personal care to 26 people across Hampshire.

What life is like for people using this service:

•People did not always receive a service that provided them with safe, effective and high-quality care.

•The management of risk was not always ineffective and placed people at risk of harm.

•The management of medicines was not always effective which meant people were at risk of harm.

•People’s human rights were not always upheld as the principles of the Mental Capacity Act 2005 were not understood by care workers.

•People were not always provided with support that was personalised to them.

•The service was not well led and there was a lack of robust and effective quality assurance processes in place.

•People told us that care workers were very good and that they were happy with the service being provided.

•More information is in the detailed findings below.

Rating at last inspection:

The service was first registered with the Care Quality Commission on 14 March 2018. This was their first inspection since registration.

Why we inspected:

This was a planned comprehensive inspection. Newly registered services are inspected within a year of their first registration.

Follow up:

At this inspection the service has been rated 'Inadequate'. Therefore, the service is now in 'Special Measures'. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. 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 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.

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.