Archived: Inspire (UK) Care

Inspire (UK) Ltd is a domiciliary care agency providing personal care in people’s own homes. At the time of the inspection the service was providing care and support to 28 people.

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

People and their relatives were generally happy with the care and support they received. However, most people and their relatives told us call schedules were poorly managed, which sometimes lead to late or missed visits. Since the last inspection the provider had moved many of their record keeping and quality assurance systems to an electronic system. Due to poor integration of the new system, it was not always effective at monitoring the quality and safety of services provided and we found a number of record keeping gaps in people’s care files.

People told us they felt safe in the company of staff and practices which promoted safer recruitment decisions had improved. Staff were trained to administer people’s medicines and most people received their medicines as prescribed. People were supported by staff who were competent and skilled. Staff asked people for their consent before providing them with any care. People who used the service 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 consistently told us staff were kind and they mostly received support from the same core group of staff, which promoted good continuity of care. People’s care plans provided clear instructions for staff to follow on how to meet their needs. Staff provided personalised support and actively encouraged people’s independence whilst delivering care. However, information contained in people’s care plans did not always support staff with this practice, such as recording which tasks people could do for themselves and what they needed support with.

Most staff told us the registered manager was supportive and operated an 'open-door' policy. The registered manager and staff were keen to deliver a high-quality, person-centred service. During and after the inspection the registered showed they were committed to addressing our concerns.

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 16 October 2018) and there were two breaches of the 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 enough improvement had not been made/sustained, and the provider was still in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three inspections.

Why we inspected

This was a planned inspection based on the date of registration of the service.

Enforcement

We have identified breaches in relation to the systems of governance.

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. 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.

Our last inspection at Inspire UK Care took place on 22 August 2017. The service was rated Requires Improvement overall. We found the service was in breach of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. Regulation 18, Staffing and Regulation 17, Good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of one of these Regulations. Further improvements were needed to meet one regulation.

There was a registered manager at the service who was also the registered provider and registered with CQC. 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 and associated Regulations about how the service is run.

We found there were systems in place to protect people from the risk of harm. Staff we spoke with were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people, and these had been reviewed to reduce the risks were in place to ensure people's safety.

We received mixed views from people about the support provided to them. Some people and their relatives spoke very positively and told us they felt safe and their support workers were respectful and kind. Some people told us they received a consistent and reliable service that met their needs. Other people had concerns about the times of their visits and the reliability of the service.

Staff recruitment records were not robust and did not promote people’s safety.

We found systems were in place to administer people’s medicines safely. The service adhered to the local authority policy for the safe administration of medicines. There were still some improvements to the medicine administration records needed.

Some staff and people felt earlier in the year there were not enough staff to provide an effective service. People and staff said the numbers and deployment of staff had improved over the last two months, so there were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice. People had consented to receiving care and support from Inspire (UK) Care.

We found staff were provided with a regular programme of training, supervision and appraisal. Some staff would benefit from more specialised training to enable them to effectively meet the more complex support needs of some people.

People we spoke with made positive comments about their support workers and told us they were treated with dignity and respect.

People's care plans contained information about their care and support, including risk assessments and action plans. These were reviewed and updated in line with the person's changing needs.

Staff we spoke with knew the people they were supporting very well and had developed a positive relationship with them. In our conversations with staff they displayed consideration and respect for people.

People said they could speak with their support worker or the manager if they had any worries or concerns and most felt they would be listened to. Some relatives we spoke with felt concerns they had raised had not been effectively handled or responded to.

We found some records were not adequately maintained and some systems or processes did not operate effectively to assess, monitor and improve the quality and safety of the service and mitigate risks to the health, safety and welfare of people.

We found breaches in two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was a breach of Regulation 19, Fit and proper persons employed and a repeated breach of Regulation 17, Good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Inspire (UK) Care is registered to provide personal care. Support is provided to people living in their own homes throughout the city of Sheffield. The office is based in the S5 area of Sheffield, close to transport links.

This inspection took place on 22 August 2017 and short notice was given. We told the registered manager two days before our visit that we would be coming. This was to ensure we had time to arrange visits with, contact people who used the service and speak with the registered manager and staff.

At the time of this inspection Inspire (UK) Care was supporting 48 people whose support included the provision of the regulated activity 'personal care'.

There was a registered manager at the service who was also the registered provider and registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at Inspire (UK) Care took place on 14 July 2016. Following the inspection the service was rated as requires improvement. At that inspection we found breaches in two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a breach in; Regulation 9: person centre care, because short, early or late visits meant the care and treatment of service users was not provided in a safe way, was not appropriate and did not meet people’s needs. There was a breach in Regulation 13: safeguarding service users from abuse and improper treatment because systems were not operated effectively to protect people from financial abuse. Requirement notices were given for these breaches in regulation and the registered provider was told to make improvements. On this inspection we checked improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these regulations.

The majority of people told us they felt safe with the support they received from Inspire (UK) Care. However, some people said at times they did not know some of the male staff who were visiting them and this caused them anxiety and on occasions they said they were frightened.

We found people were protected against the risks associated with medicines because the registered provider had appropriate arrangements in place to manage medicines and to ensure staff were appropriately trained. There were still some improvements to the auditing of medicine records needed.

A thorough recruitment procedure was in operation. Staff were aware of whistleblowing and safeguarding procedures.

We found staff were provided with a regular programme of training, supervision and appraisal although some staff did not have the correct skills or competency to meet people’s needs.

There had been improvements to the scheduling, delivery and length of care calls to enable all people using the service to experience continuity of care. Some people were dissatisfied with their new support contracts which meant their visit times could be in a three to four hour time window.

People we spoke with made positive comments about the care staff and told us they were treated with dignity and respect.

People's care plans contained information about their care and support, including risk assessments and action plans. These were regularly reviewed and updated in line with the person's changing needs. The daily care records required some improvement to ensure they were respectful to the person and were maintained as a legal document.

Most people said they had regular contact with the registered manager and if they had any concerns or worries they were confident the registered manager and staff would listen to them and look at ways of resolving their issues. Some people felt they weren’t listened to.

There were a variety of methods available for the registered provider to assess and monitor the quality of the service; however, records of these checks were not being maintained on a regular basis. We found some quality assurance processes completed were not effective in ensuring compliance with regulations and identifying areas requiring improvement.

We found two breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in regulation 18: Staffing and regulation 17: Good governance.

You can see what action we told the provider to take at the back of the full version of the report.

At the time of this inspection Inspire (UK) Care was supporting 13 people whose support included the provision of the regulated activity ‘personal care’.

There was a registered manager at the service who was also the registered provider and registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at Inspire (UK) Care took place on 9 September 2014. The service was found to be meeting the requirements of the regulations at that time.

This inspection took place on 7 and 8 June 2016 and short notice was given. We told the registered manager and business support manager two working days before our visit that we would be coming. We did this because the registered manager is sometimes out of the office supporting staff or visiting people who use the service. We needed to be sure that the registered manager would be available.

People supported by the service and their relative’s spoke positively of the care workers that visited them. People said they felt safe with their care workers.

We found systems were in place to make sure people received their medicines safely.

The provider did not have adequate systems in operation to ensure the safe handling and recording of people’s money to protect people.

Staff recruitment procedures ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff had a good knowledge of the people they were supporting.

Some people said that the timing of visits did not always meet their needs. Some visits were late or too close together. Some people reported occasional missed visits. This meant the service was sometimes unreliable and ineffective.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and the principles of the Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

Each person had a care plan that accurately reflected their needs and wishes so that these could be respected. Support plans had been reviewed to ensure they remained up to date.

Some people supported, and their relatives or representatives said they could speak with staff if they had any worries or concerns and felt they would be listened to. Other people told us they found the office staff less reliable as they were not always informed if visits would be late and some calls were not returned.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via surveys and the results of these surveys had been audited to identify any areas for improvement.

We found two breaches in two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 13: Safeguarding service users from abuse and improper treatment and Regulation 9: Person centred care.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with one professional who had involvement with the agency to obtain their views of Inspire (UK) Care.

We spoke with the registered manager, the business manager the care coordinator and six care staff about their roles and responsibilities.

We gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People supported by the service told us they felt safe.

We observed, and people told us they felt their rights and dignity were respected.

Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Is the service effective?

Staff were provided with training to ensure they had the skills to meet people's needs.

People and relatives told us they were happy with the care and support staff provided and people's needs were met. Staff had a good understanding of people's care and support needs and they knew how to meet them and avoid unnecessary risks.

Other professionals and individuals were involved in regular meetings and reviews with each individual to ensure their care and support was still appropriate.

Is the service caring?

We asked people using the service, or their relatives for their opinions about the support provided. Feedback from people was positive, for example, 'the staff are always respectful,' "they are kind and helpful. They address issues straight away" and 'they are supportive and amenable'.

People using the service and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People's needs were identified and reviewed so any changes were responded to.

People spoken with said they knew how to make a complaint if they were unhappy. We found appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

The provider did not have effective recruitment procedures in place. Staff did not always have required documentation and verification in place before commencing employment.

People were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. The service did not ensure staff were trained appropriately and that training was updated where required.

People who used the service told us that the care and support they received was suited to their needs. One person told us "They stay for how long they're meant do and do what they need to do for me.'

The provider had suitable arrangements in place to ensure that people who used the service were safeguarded against the risk of abuse.

People were cared for by staff who were properly trained, supervised and supported.

The service had adequate quality monitoring systems in place.