Eternal Care UK Limited

Eternal Care UK Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is to help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection 55 people were receiving personal care.

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

People and their relatives told us people were safe and that staff treated people well. The registered manager completed risk assessments for each person using the service. Staff administered people’s medicines safely and protected people from the risk of infection. People were supported by effectively deployed staff and the registered manager monitored visits. The provider carried out comprehensive background checks of staff before they started work. The provider had a system in place to manage accidents and incidents.

People’s care plans reflected their current needs. Staff showed an understanding of equality and diversity. Staff respected people’s choices and preferences. People knew how to make a complaint. The registered manager knew what to do if someone required end-of life care.

Systems and processes to assess, monitor and improve the quality and safety of the service were in place. There was a clear management structure in place and staff were aware of the roles of the management team.

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 December 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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 Key Questions safe, responsive and Well-led which contain those requirements.

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 changed from requires improvement to good. 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 Eternal Care UK Limited on our website at www.cqc.org.uk.

Eternal Care UK Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is to help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection 76 people were receiving the service, of which there were 48 people receiving personal care.

People’s experience of using this service:

There were no detailed risk assessments for some people with a health condition. The provider had not always identified some of the issues we found at this inspection or acted upon them in a timely manner in relation to people with catheter care and diabetes.

We made one recommendation in relation to the accessible information for people.

People and their relatives gave us positive feedback about their safety and told us that staff treated them well. Senior staff completed risk assessments for people with guidance for staff on how to reduce risks. The medicines were managed safely. People received calls as required. The provider carried out comprehensive background checks of staff before they started work. The provider had a system to manage accidents and incidents.

Staff received support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach the manager at any time for support. The provider worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent, where they had the capacity to consent to their care. 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.

The assessment of people’s needs had been completed to ensure these could be met by staff. The provider worked with other external professionals to ensure people were supported to maintain good health. People were involved in making decisions about their care and support. People were treated with dignity, and their privacy was respected, and supported to be as independent in their care as possible.

People’s care plans reflected their current needs. Staff showed an understanding of equality and diversity.. Staff respected people’s choices and preferences. People told us they knew how to make a complaint and would do so if necessary. The manager was aware of what to do if someone required end-of life care.

Notwithstanding the above, we found there were arrangements in place to assess and monitor the quality of care being provided. There was a management structure at the service. Staff were aware of the roles of the management team. They told us the manager was approachable. People and their relatives commented positively about staff and the manager. The provider had worked effectively in partnership with a range of professionals and acted on their advice.

Rating at last inspection and update

The last rating for this service was inadequate (published 22 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the inspection to show what they would do and by when to improve. At this inspection the provider demonstrated most of the improvements have been made.

This service has been in Special Measures since October 2018. 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.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risk assessment and their management including effective quality assurance system and process at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People’s experience of using this service:

At our comprehensive inspection of 28 June 2016, we found the provider had not acted to make sure medicines were managed safely. We took enforcement action. At our inspection on 12 and 13 December 2016, we found that the provider had addressed the breaches of regulation, however at the 2 and 3 August 2018 inspection we found that these improvements had not been sustained and we took enforcement action. At this inspection, we found the provider had not made sufficient improvements for managing medicines since the last inspection. Medicines were still not always being managed safely.

At the inspection on 2 and 3 August 2018, we found staff did not always attend people's care calls as required. The provider sent us an action plan and told us that they would complete all required actions by 5 October 2018. However, when we returned to the service on 28 and 29 March and 2 April 2019, we found this was not the case.

At the inspection on 2 and 3 August 2018, we found there was no risk assessments for people using bedrails and risk assessment reviews were not completed for people who had come out of hospital. At this inspection we found there was no risk assessments and management plans for people with challenging or complex behaviour at times.

At the inspection on 2 and 3 August 2018 we found when people lacked the capacity to make important decisions for themselves the provider had failed to maintain a record of decisions made in their best interests, in line with the Mental Capacity Act 2005. At this inspection we found the provider had not made improvements, when people lacked capacity to make important decisions for themselves to ensure that their rights were protected.

At the inspection on 2 and 3 August 2018 we found two people’s care plans did not reflect people’s current needs. The provider sent us an action plan and told us that they would complete all required actions by 5 October 2018. However, when we returned to the service on 28 and 29 March and 2 April 2019, we found improvements had not been made.

At our last comprehensive inspection on 28 June 2016 we found that effective systems were not in place to monitor and improve the quality and safety of the service provided to people. At the inspection on 12 and 13 December 2016, we found that the provider had addressed the breaches of and were compliant with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.However, at the inspection on 2 and 3 August 2018 we found the provider had not always ensured that they monitored people’s calls to check if they were attended as per their scheduled time through an electronic or a manual call monitoring system.

At this inspection we found call monitoring was not effective. The electronic call monitoring system did not provide accurate records of staff visits.

A people’s satisfaction survey carried out in July 2018 was not analysed and an action plan was not developed to drive any improvements. The provider had not ensured that people’s information and their records were maintained safely.

People’s needs were assessed to ensure these could be met by the service.

The provider trained staff to support people and meet their needs. Staff told us they felt supported and could approach the new manager at any time for support.

Staff supported people to eat and drink enough to meet their needs.

People were protected from the risk of infection. The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.

The provider worked with other external professionals to ensure people received effective care. People were supported to maintain good health.

The provider completed home environment assessment and made referral to external professionals for their support.

Staff supported people and showed an understanding of equality and diversity. People and their relatives were involved in the assessment, planning and review of their care. People were treated with dignity, and their privacy was respected. The provider had a policy and procedure to provide end-of-life support to people.

People told us they knew how to complain and would do so if necessary.

The new manager and staff worked as a good team. The service had an on-call system to make sure staff had support outside office working hours and staff confirmed this was available to them.

The new manager encouraged and empowered staff to be involved in service improvements through periodic meetings. People and their relatives were involved in the planning and review of their care and support.

The new manager completed checks and audits on accidents and incidents, complaints, staff training, and safeguarding. The senior staff carried out spot checks of staff to ensure care was provided as planned.

The new manager and the provider remained committed to working in partnership with other agencies and services to promote the service and to achieve positive outcomes for people.

Rating at last inspection: Inadequate (report published on 17 October 2018).

Why we inspected: This was a planned inspection based on the last inspection rating.

Enforcement: Action we told provider to take (refer to end of full report)

The overall rating for this service is ‘Inadequate’ and the service remains 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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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.

Follow up: We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.

The service had a registered manager in post. A registered manager 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 inspected Eternal Care UK Ltd on 28 June 2016 and found significant shortfalls. We found multiple breaches of the fundamental standards and regulations. The service was rated inadequate and placed into special measures. Allegations of abuse had not been reported to the local authority as required. Medicines were not managed safely, and people were not always supported to receive their medicines as prescribed by healthcare professionals. Risk assessments were not always reflective of people's needs, and appropriate steps were not in place to mitigate future risks. Effective systems or processes were not in place to assess, monitor and improve the quality of the service. The provider had not submitted statutory notifications to the CQC, as required by law.

We took enforcement action and issued a warning notice relating to 'Safe Care and Treatment.' We placed a positive condition on the provider's registration which prevented them from taking on new clients. We required the provider to make improvements and the service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

Following this inspection, we inspected the service on 12 and 13 December 2016. We found that the provider had made improvements and the service was no longer in breach of any of the fundamental standards and regulations. We revised and improved the rating the service to 'Requires Improvement' as the system and processes that have been implemented had not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice.

At this inspection we found that the provider had not sustained the necessary improvements. The provider had not ensured medicines were managed safely. There were not always up to date and accurate records of the medicines people were prescribed. The provider’s audits of people's medicines were not effective. The provider and registered manager had not raised safeguarding alerts as required.

Staff told us if people’s needs changed, these were discussed with people and their relatives as appropriate to ensure that the service met their needs. However, two of the 10 the care plans we reviewed did not reflect people’s current needs, and had not been updated when their needs had changed. We brought this to the attention of the registered manager and the director, they told us that all these care plans would be updated immediately. Following the inspection, they confirmed that the two care plans had been updated.

The provider did not always have enough staff to support people safely.

We received a mixed response from people and their relatives about the management of the service.

The provider had not always monitored people’s calls to check staff had attended as per their agreed time. There was no communication record to show that office staff had informed people when staff were running more than 15 minutes late. Also, on some occasions staff had spent less time with people than agreed, and this had not been followed up by the management team.

Quality assurance systems were in place to monitor the quality of the service being delivered. However, the provider had not always identified the serious concerns we found at this inspection. The provider had not ensured that people’s information and their records were maintained safely.

Staff completed a risk assessment for every person when they started using the service. However, there was no risk assessment and management plan for people using bedrails and this required improvement.

We did see some areas of good practice with safeguarding. The service had a policy and procedure for safeguarding adults from abuse. All staff told us they completed safeguarding training and the training records we looked at confirmed this.

People 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. People consented to their care before it was delivered. However, some people lacked capacity to make important decisions about their care and the provider and registered manager had not documented best interest decisions, when decisions had been made on their behalf.

The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again. The provider carried out satisfactory background checks of all staff before they started working. This reduced the risk of unsuitable staff working with people who used the service. Staff followed infection control procedures to reduce infection from spreading.

Staff supported people to eat and drink enough to meet their needs. People’s relatives coordinated their health care appointments and health care needs, and staff were available to support people to access healthcare appointments if needed. People’s personal information about their healthcare needs was recorded in their care records.

People and their relatives told staff were caring. People were supported to be as independent in their care as possible. Staff involved people and their relatives, where appropriate, in the assessment, planning and review of their care. People’s care records showed that they were involved in planning and subsequent reviews of their care. Staff showed an understanding of equality and diversity. The service had a clear policy and procedure for managing complaints. People knew how to complain and told us they would do so if necessary. The provider had systems and processes in place to support people with end of life care in line with their wishes.

The registered manager held staff meetings, where staff shared learning and good practice so they understood what was expected of them at all levels. Staff described the management of the service positively. We observed the manager interacting with staff in a positive and supportive manner throughout the time of our inspection.

People who used the service completed satisfaction surveys for the period July 2017 to December 2017. The service worked effectively with health and social care professionals and commissioners. Feedback from a social care professional stated that the provider continued to make improvements in relation to call monitoring and accidents and incidents management.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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.

At our previous comprehensive inspection on 28 June 2016 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission Registration Regulations. We found the provider had not taken action to support people where allegation of abuse was raised and the appropriate bodies were not notified. The provider had not taken action to make sure medicines were managed safely. There was not always an up to date and accurate records of the medicines people were prescribed. People were being placed at risk of receiving poor care and treatment because staff had not received the appropriate training and supervision to enable them to carry out their duties. Effective systems were not in place to monitor and improve the quality and safety of the service provided to people.

Following that inspection we imposed urgent conditions on the provider’s registration at the location. We told the provider to not provide personal care to any new service user without the prior written agreement of the Care Quality Commission (CQC). We told the provider to immediately undertake a thorough and comprehensive review of all records to identify whether there were any matters which should have required or do require safeguarding referrals to be made and, if so, to make any safeguarding referrals immediately. We told the provider to carry out monthly medicines audits and send CQC a report of actions taken as a result of these audits. We also placed the service in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months.

The provider had not provided personal care to any new service user since the last inspection. They sent us reports from the results of the audits they carried out and the improvements they had made. As the provider had demonstrated improvements and the service is no longer rated as inadequate for any of the five key questions, it is no longer in special measures.

At this inspection we found that the provider had taken action to support people where allegations of abuse had been raised and the appropriate bodies had been notified of the incident. People and their relatives told us they felt safe with the staff. The service had clear procedures to recognise and respond to abuse. All staff completed safeguarding training. People’s medicines were managed appropriately and they were receiving their medicines as prescribed by healthcare professionals. Senior staff completed risk assessments for people who used the service which provided sufficient guidance for staff to minimise identified risks. The service had a system to manage accidents and incidents to reduce reoccurrence.

The provider had taken action to make sure that the systems for monitoring and improving the quality and safety of the services provided to people were operating effectively. The service sought the views of people who used the services. Staff felt supported by the provider.

The service provided an induction and training, and supported staff through regular supervision and annual appraisal to help them undertake their role. The service had enough staff to support people and carried out satisfactory background checks of staff before they started working. The service had an on call system to make sure staff had support outside the office working hours.

The service did not have a registered manager in post. A registered manager 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. However, the current manager had applied to the CQC to become a registered manager for the service.

People’s consent was sought before care was provided. The service manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation.

Staff supported people with food preparation. People’s relatives coordinated health care appointments to meet people’s needs, and staff were available to support people to access health care appointments if needed.

The provider involved people about their care and support needs. Staff supported people in a way which was caring, respectful, and protected their privacy and dignity. Staff developed people’s care plans that were tailored to meet their individual needs. Care plans were reviewed regularly and were up to date.

The service had a clear policy and procedure for managing complaints. People knew how to complain and would do so if necessary. The service had maintained a complaints log, which showed when concerns had been raised senior staff investigated and responded in a timely manner to the complainant.

The service worked effectively with health and social care professionals and commissioners. Feedback from social care professionals also stated that the standards and quality of care delivered by the service to people was good and that they were happy with the management and staff at the service.

The service did not have a registered manager in post. A registered manager 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.

During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff were not always clear on how safeguarding concern’s should be escalated. The provider had had not always taken appropriate steps to protect people from abuse and improper treatment by making safeguarding referrals.

Medicines were not managed safely by the service because records relating to the management of medicines were often not fully complete. Risk assessments were not always reflective of people’s needs or reviewed in line with the provider’s policy to mitigate risks to people using the service.

Staff were not up to date with the provider’s mandatory training requirements, and did not always receive regular supervision and appraisal in line with the provider’s policy.

The provider did not operate effective systems to monitor and mitigate risks to people because regular audits were not in place, and they had therefore failed to find concerns we identified at inspection.

We also found a breach of the Care Quality Commission (Registration) Regulations 2009 in respect of notifying the CQC of changes, and notification of other incidents.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People that use the service told us that they felt safe. There was a whistle-blowing procedure available. Staff were safely recruited with necessary pre-employment checks carried out. There were enough staff to meet people’s care and support needs.

Staff completed an induction when they started work. However, did not have a good understanding of the Mental Capacity Act 2005 (MCA) and this was an area which required improvement. People were supported to maintain a balanced diet so that their dietary needs were met. People were supported to access healthcare professionals as and when required.

People were treated with dignity and respect, and their privacy was taken into account. People’s care plans provided guidance for staff on how to support them in a way which met their needs, however care planning required improvement to reflect people’s involvement in expressing their views and wishes. Staff were aware of the complaints procedure and said they were confident that complaints would be dealt with appropriately. However improvement was required because records showed complaints had not always been dealt with effectively.

Staff said they enjoyed working at the service and they received good support from the management team. People’s opinions were sought through an annual survey.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

People who used the service we spoke with told us they were happy with the service they received. People told us that the staff were respectful and were almost always on time in attending their home. People said that information was provided to help them to make an informed decision about their treatment, and this was done before the care was first provided.

People told us they were always treated in a respectful manner, and the staff knew them well and understood how to attend to their needs. Everyone we spoke with said that the staff explained what they were doing and involved them in decisions about their care, and in reviewing their care plans. One person said: 'the staff are friendly and respectful and always pick me up when I'm feeling low by chatting to me'. Another person said: 'the agency staff are always the same ones and are always on time, they stay extra time if I have any problems that need sorting'. Everyone we spoke with said that the staff communicated well with them and understood their needs. These comments were reflective of the comments we received from the majority of people we spoke with. People said they were given choices about how their care was delivered and that they felt safe and well cared for.

The staff understood how to keep people safe and understood their responsibilities for reporting concerns if necessary. The provider ensured that the staff were trained and supervised so that they were up to date in their practice and supported people safely. A number of people we spoke with who used the service said that the staff were monitored by supervisors from the agency who regularly visited them to observe their work practices. There was a system in place to effectively respond to people's concerns and complaints, and people told us that they knew how to complain if they needed to, but the majority of people said they never needed to complain.

All of the people we spoke with who used the service told us they were involved in the planning of their care, and had been asked for their views when reviews were carried out. We reviewed information five people's care and found that their care needs were being planned for. We spoke with staff and found that they understood people's care needs and how to protect them from risk and harm.

We found that staff had adequate training and supervision and were supported by the agency's management to do their job. Staff we spoke with said the management were supportive and the training was really good. The provider used effective systems to regularly check that care was being provided safely and appropriately including regular unannounced spot checks on staff during their working day. Some staff said that they found this helpful as it resulted in getting good direction in their work.