Compare Care Limited

Compare Care provides personal care for people in their own homes, most of whom were older people with associated health needs. 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. At the time of this inspection the service was providing personal care to nine people.

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

Since the last inspection the registered manager and the staff have made improvements which has raised the standard of care people received and the overall governance of the service. The registered manager was reviewing and updating care plans, to ensure they accurately described people’s history, their background, aspirations, goals, likes and dislikes. This is an ongoing area of required improvement.

Since the last inspection, the registered manager had improved their systems to monitor the quality of the services provided. This included conducting weekly and monthly audits checking care plans, monitoring records, medication records and people’s visits. These improvements were yet to be fully embedded and sustained.

People and relatives told us their experience of the service had improved and were positive about their support visits. People and relatives had confidence in the reliability of the service and spoke highly of the care. A relative said, “I have to say that there has been a definite improvement, my relative has a new carer who is lovely. I have sent a letter to the company complimenting this member of staff.”

People felt safe using the service and staff understood what their responsibilities were in relation to keeping people safe. People had risks associated with their health and wellbeing, assessed and managed to ensure they received personal care and support safely. A person said, “I feel safe with the care I am getting.”

Staff administered people's medicines safely and prevented people from the risk of cross infection. The service worked in partnership with people, relatives and other agencies to support people's good health and wellbeing and provide consistent 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.

Staff were trained and their competency was checked by the registered manager following an induction into the role to ensure staff had the skills to do their job well and effectively meet people's needs.

Staff received supervision to support them in their role and identify any learning needs and opportunities for professional development. The registered manager carried out spot checks on staff to monitor the quality of the service provided and to seek the views of the people who were supported.

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 06 January 2022) and there were 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.

This service has been in Special Measures since 6 January 2022. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Compare Care provides personal care for people in their own homes, most of whom were older people. 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. At the time of this inspection the service was providing personal care to 19 people.

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

People had mixed experiences of the service. Most people spoke highly of the care and described caring staff but some people’s service had been disrupted due to staffing difficulties. Some people had not received the visits they needed and this had an impact on people’s safety, dignity and their confidence in the reliability of the service. One relative described how visits had been missed and commented that staff rotas were not well managed. Another relative said, “The rotas are not well managed, the staff have told me they have three clients at the same time so how are they supposed to do that?”

Systems for managing medicines were not always robust. Some people had not received their visits and consequently their prescribed medicines had not been administered by staff. Records for monitoring administration of medicines were not consistently accurate and this meant the registered manager could not be assured that people were receiving their medicines safely.

Staff told us they were concerned about the current staffing difficulties and management issues at the service. One staff member told us, “The clients are not getting calls that they are supposed to because there’s not enough staff.”

Systems for planning and monitoring care visits were not consistently managed. There were not always enough staff to cover all the visits and management of the service was inadequate. The provider was also the registered manager of the service. They were responsible for planning and monitoring care, training and managing staff and driving the improvements required following the last inspection. The lack of effective systems and management support meant they had failed to make the required improvements and the standard of service had continued to decline.

Staff had not receiving the training, support and guidance they needed to provide safe and effective care. Some staff were undertaking tasks for which they had not been trained and assessed as competent, this had put people at risk of harm. Staff were not all clear about current guidance for COVID-19 and when PPE, including masks, should be worn. Management oversight and governance arrangements had not been effective in identifying these shortfalls.

An electronic monitoring system was in place to support the delivery of the service. Staff had not received sufficient training and support in how to use the system. This meant that records were incomplete, inaccurate and did not provide a true reflection of the care provided.

Risk assessments and care plans were not comprehensive or personalised. There had been minimal impact for people because staff knew them well and understood their needs. However, when new or unfamiliar staff attended care visits, they did not have all the information they needed to provide care safely or in a personalised way.

People and relatives spoke highly of their regular care staff who they described as kind and caring. One person said, “As far as we are concerned, they do a grand job and we are happy with them.” Other comments included, “I am happy and have confidence in them,“ and, “I think they( [staff]) are self -motivated because they love what they are doing.”

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.

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 21 September 2021), and there were continued breaches of regulations. We issued warning notices to the provider requiring them to make improvements. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and poor management of the service. A decision was made for us to inspect and examine those risks and to follow-up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to management of medicines, management of risks, record keeping and management oversight and governance at this inspection.

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 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.

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 the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Compare Care provides personal care for people in their own homes, most of whom were older people. 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. At the time of this inspection the service was providing personal care to 24 people.

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

Care plans did not always contain detailed information about people’s health conditions and staff had not always received training in these areas, for example , a care plan of a person who lived with epilepsy contained no information or guidance for staff of actions to take if the person experienced a seizure. Where risks had been identified, these had not always been considered within care or risk planning processes so they could be mitigated. Incidents had not always been managed in accordance with safeguarding practice and CQC had not always been notified of abuse, as required. Records relating to medicines were not always completed accurately.

We identified improvements which had been made to recruitment processes. People and relatives told us they felt they received a safe service from staff who knew them well. They had appreciated how the service had provided small core staff teams who worked with them regularly.

Most staff told us they received regular support from the registered manager mainly through “spot checks” when they were working with people. Staff did not always receive enough training or supervision. Staff told us about their detailed induction process which covered essential training however, there was no formal process to ensure this was kept updated.

Systems and processes did not effectively identify or manage concerns found with care planning, medicines or safeguarding this has remained in need of improvement. A registered manager was in post who was also a director of the company. People, relatives and staff were generally positive about the registered manager.

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.

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 17 December 2019) and there were multiple breaches of regulation. The provider was required to complete an action plan after the last inspection to show what they would do and by when to improve.The provider was not able to demonstrate this had been completed.

At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 17 October 2019 breaches of legal requirements were found. The provider had not completed an action plan after the last inspection to show what they planned to do and by when to improve safe care and treatment, fit and proper persons employed and good governance.

We undertook this focused inspection to check improvements had been made and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective 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 remained requires improvement. 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 Compare Care Limited 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people from abuse and improper treatment, safe care and treatment, staffing and good governance at this inspection

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 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.

Compare Care provides personal care for people in their own homes, most of whom were older people. 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. At the time of this inspection the service was providing personal care to 19 people.

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

The provider did not always carry out robust checks to ensure staff were suitable to work with vulnerable people. There were enough staff to support people safely although some people told us timekeeping could improve. The provider assessed risks to people although these assessments did not always follow best practice and were not always comprehensive. Records and checks relating to medicines management required improvement as these were not always robust. Staff followed suitable infection control practices.

Staff received training during their induction with annual training in moving and handling. However, staff did not always receive sufficient training nor supervision after their induction. The provider checked staff cared for people in line with their care plans through observations. People received the support they needed to maintain their day to day health and in relation to eating and drinking. 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.

People and relatives were positive about their care workers who treated people with kindness, dignity and respect. People were involved in their own care and planning and received care from staff who knew them well. People’s care was personalised to meet their needs and preferences. Some people received social and emotional support from staff and this support was based on the individual’s needs. The provider could provide information to people in alternative formats to meet people’s communication needs. The provider had a suitable process in place to respond to any concerns or complaints.

A registered manager was in post who was also a director of the company. People, relatives and staff were positive about the registered manager and thought the service was well-led. However, because the provider’s governance systems had not identified and resolved the issues we found including those relating to recruitment, medicines management and risk assessments we found the leadership required improvement.

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

Rating at last inspection and follow up

The last rating for this service was good (report published April 2017).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Compare Care Limited is a domiciliary care service which provides personal care and support services for a range of people living in their own homes. These included older people and people living with dementia. At the time of our inspection 17 people were receiving a service.

The service is owned by a provider who is also the registered manager. 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.

Staff had a firm understanding of how to keep people safe and there were appropriate arrangements in place to manage risks. One person told us “I Feel safe, they do things correctly, very nice carers”. There were enough staff employed to care for people safely and the provider had procedures in place to ensure that staff were suitable to work with people. People were supported to receive their medicines safely in line with current regulations and guidance.

Staff told us they had received training and were confident to meet people’s needs. Staff were happy with the level of support they received and told us that communication with senior staff was good. One member of staff said “We have options to do training from the local authority as well. I am booked on an end of life course next week”. Staff had a good understanding of the responsibilities with regard to the Mental Capacity Act 2005 (MCA).

People were supported to have enough to eat and drink. Care plans guided staff in offering people choices and monitoring people’s nutrition and hydration when needed. Staff supported people to have access to health care services when they needed them. One relative told us “Staff will call and contact me if there are any problems or concerns, they are good like that”. Staff told us they knew people well and recognised if they were unwell.

Staff told us they had developed positive relationships with the people they were caring for. People and relatives spoke highly of the caring nature of the staff. Their comments included, “Carers are very good, kind attentive and gentle” and “There the best, very good all of them". Staff had a firm understanding of how to protect people’s privacy and maintain their dignity. People were involved in planning their care. A relative said “The care plan is used and reviewed in the year”.

Care plans were personalised and detailed. They guided staff in how people wanted their care to be provided. Staff were responsive to changes in people’s needs. Staff were able to support people to maintain relationships and to follow interests, for example by accompanying people on outings. One member of staff told us that the person they cared for enjoyed going out in the car shopping or somewhere else of their choice.

The registered manager monitored the quality of the service by the use of regular checks and internal quality audits to drive improvements. Feedback was sought by surveys which were sent to people and their relatives. People and relatives we spoke with were aware of how to make a complaint and felt they would have no problem raising any issues. One person told us “I had one concern and spoke to the manager, and it stopped”.

Staff felt they had good communication with the registered manager and supervisor through meetings that had been held, phone calls and coming into the office. Comments from staff included “I feel supported and if I need any help, I can call up and someone is always there for me” and “Yes my manager is very good and helpful”.

Compare Care Limited provides personal care and support to people who wish to retain their independence and continue living in their own home. Personal care and support is provided for older people and people living with a disability. At the time of our inspection 15 people were receiving a care service.

The service had a registered manager. 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.

Care staff had not received full training on the requirements of the Mental Capacity Act 2005 (MCA) and identified the registered manager had failed to ensure policies and procedures relating to the MCA 2005 were in place and readily available to staff. This meant that staff would not be aware of the correct procedure to follow should there be concerns relating to someone's mental capacity. We have therefore identified this as an area of practice that needs improvement.

The registered manager monitored the quality of the service by the use of checks and internal quality audits. We found audits to be inconsistent in quality and not always recorded when they had been carried out. The absence of detailed auditing also meant the registered manager could not be assured of the quality of service delivered. We have therefore identified this as an area of practice that needs improvement.

The experiences of people were positive. People told us they felt safe and staff were kind and the care they received was good. One person told us “I feel very safe when the care staff look after me”. A relative told us “Very safe and must say trustworthy, all of the staff”

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The registered manager made sure there was enough staff at all times to meet people’s needs. When the provider employed new staff at the service they followed safe recruitment practices.

Assessments were undertaken to identify people’s support needs and care plans were developed outlining how these needs were to be met. We found that care plans enabled staff to provide the individual care people needed. People told us they were involved in the care plans and were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

The provider had arrangements in place for the safe administration of medicines. People were supported to receive their medicine when they needed it. People were supported to maintain good health and had assistance to access to health care services when needed.

People were supported at mealtimes to access food and drink of their choice and were supported to undertake activities away from their home.

There were clear lines of accountability. The service had good leadership and direction from the registered manager. Staff felt supported by management to undertake their roles. Staff were given supervision and development opportunities. For example staff were offered to undertake additional training and development courses to increase their understanding of needs of people using the service.

People and relatives said how happy they were with the management of the service. One person told us “The manager is very nice to talk to. He comes to see me and checks everything is ok for me”.

People and relatives we spoke with were aware of how to make a complaint and felt they would have no problem raising any issues. The registered manager responded to complaints in a timely manner with details of any action taken.

Our inspection team comprised an inspector. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We spoke with three people who used the service, one relative and three care staff. All interviews were carried out by telephone after we had visited the office. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We checked some daily records and found that care and support had been provided to people in line with the information recorded in their care plans. In one person’s daily record, we saw the time the care worker arrived, the time they left and what support they had provided. Each entry had been signed off by the member of staff who had undertaken the visit. One member of staff told us that they always looked at the daily record to see what care had been provided at the previous visit.

We saw that the provider undertook checks with the Disclosure and Barring Service (DBS) for all relevant staff. These checks had been undertaken by a company that provided DBS checks electronically, as an on-line service. This meant that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening and that there were effective recruitment and selection processes in place.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes and to agencies providing care. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

We looked at people’s care records and saw that people were consulted in regular reviews of their care needs. People we spoke with confirmed this. One person told us that a member of staff came round to visit them, specifically to review their care plan. They said that they were asked if they were happy with their care and said, “Nothing’s too much trouble”.

One member of staff told us that they would meet with new people who came into the service. They said, “Before you start with a new client, you go through the care plan.” They also said that they were involved with regular reviews of people’s care plans which occurred every three months. This ensured that people’s current needs were reassessed and any changes needed were documented accordingly and the care plan updated.

The manager told us that all staff were given the opportunity to undertake additional qualifications, for example, the National Vocational Qualification (NVQ) in Health and Social Care. Two members of staff confirmed that they were studying towards an NVQ and one said, “It’s going really well”. Relatives we spoke with thought that staff were suitably skilled to do their jobs well. After completion of their induction programme, the manager told us, and staff confirmed, that they received additional training which was arranged throughout the year.

Is the service caring?

One person told us that they had the same two members of care staff who visited them and added, “I have the same two. They’re very, very good and they know exactly how to look after me. It’s all written down in the care plan. The staff always ask what I want first. Do you want to get dressed or washed – they always ask.”

The manager told us that they always tried to allocate the same care staff for people who used the service to ensure that they received consistent care. People we spoke with confirmed that they received visits from the same staff and that this was important to them. One person told us that they got on particularly well with one member of care staff, but that if a change was needed, they were always told in advance about this.

Is the service responsive?

One person told us that their care worker spent enough time with them and said, “Yes. Couldn’t fault them”. Another person said that they were always contacted if a visit time needed to be changed or a staff member was going to be late arriving and that “times were changed to suit all”. All the staff we spoke with felt that they had enough time to deliver the care that was needed.

We saw that there was a complaints policy in place and this outlined what action would be taken when a complaint was received and how this would be investigated and followed up. The manager told us that they had not received any complaints. They told us that questionnaires were sent out quarterly to people who used the service, their relatives and to staff. These would then highlight any complaints that people had or issues they wanted to raise. The manager added that relatives or people who used the service could make a complaint at any time.

Is the service well led?

We spoke with three people who used the service. One said, “They look after me well”. A relative we spoke with told us that they had been asked for their views on the service when someone from Compare Care Limited came to their house. They said they felt “Very positive” and that, “Staff couldn’t be more helpful or kind”. One member of staff we spoke with said, “I like it, it’s been good”. When we asked another member of staff how they felt about working for Compare Care, they told us, “Very good actually, I enjoy it”.

We inspected the service on 6 September 2013 to check on the provider's compliance with these areas. We found that the provider had implemented training in safe administration of medicines. However, they were unable to evidence supervision and support provided to staff. In addition, the service had not taken action to implement effective systems to identify, assess and monitor the quality of the service that people received.

We spoke with one person who used the service and four relatives. People told us they were happy with the support they received and found that staff were helpful and professional.

People expressed satisfaction with the agency and with the quality of care provided. People said that care workers treated them with respect and that they felt safe with the care and support they received. One person told us, "They are a very good agency." A relative told us, “We are completely satisfied with the care provided at this present time.”

People we spoke with also confirmed they had been given a copy of their care plan and that they had agreed to the care provided.

We looked at a selection of care records. We found that, prior to commencement of providing the service, people’s needs had been assessed. However, the manager was unable to demonstrate that planning and delivery of care had been routinely reviewed and reassessed to ensure they met people's current needs.

We also looked at a selection of care workers’ records. They demonstrated that all care workers had received induction training before commencing work to ensure they knew what was expected of them. However, the manager was unable to demonstrate that they had received further training and supervision in order to support them in their work.