We carried out a review of the data available to us about Skillcare Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Skillcare Limited, you can give feedback on this service.
People’s experience of using this service:
All the people we spoke with who used the service told us they were happy with the care they received and would recommend the service to others. People received person centred care which met their needs. People told us staff were caring and considerate.
The service had improved significantly from previous inspections. The provider had embedded improved quality monitoring processes which resulted in better outcomes for people.
Processes were in place to ensure people received their medicines safely and as prescribed.
There were enough staff available to meet people’s care needs. Most people told us that staff were on time, not rushed and stayed the allocated visit time.
Staff were suitably trained, skilled and experienced and had undergone the required recruitment checks.
People told us they were asked for their consent and felt they had the independence they wished for.
People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received.
Rating at last inspection: Requires Improvement. The last inspection report was published on 6 June 2018.
Why we inspected: This was a planned inspection based on the date and the rating of the previous inspection.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Skillcare Limited had been in special measures since our inspection in April 2016. Following an inspection in April 2017, CQC issued a Notice of Proposal to cancel the provider’s registration. We inspected in August 2017 to see if improvements had been made and following this inspection, we issued a Notice of Decision to cancel the provider’s registration. The provider appealed our decision to the First Tier Tribunal.
In January 2018 we carried out an inspection to assess if the provider had made improvements. At that inspection, in addition to ongoing concerns regarding risk assessing and medicines management, we identified concerns around staffing levels and deployment of care staff and recruitment. Due to the concerns identified at that inspection, CQC confirmed their decision to cancel the providers registration and as an additional measure, imposed a condition on the provider’s registration to restrict the taking on of new care packages without CQC authorisation. The provider appealed this decision to First Tier Tribunal.
We carried out this inspection to assess whether the provider had made improvements prior to the Tribunal which had been scheduled for May 2018. At this comprehensive inspection we found the provider had taken action to achieve compliance with all of the regulations previously identified as non-compliant during the comprehensive inspection in January 2018. Because of the improvements seen, CQC withdrew their notice to cancel the provider’s registration. We agreed with the provider that the condition to restrict them from providing a service to new people would remain on their registration, however CQC would permit the provider to provide personal care to no more than five new people per month. CQC will reassess the condition in place at a future inspection.
The service had a registered manager. In this report we will refer to this person as the 'provider' as they were also the director of the company. 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.
At this inspection, we found detailed current risk assessments were in place for people using the service. Risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.
The provider had made improvements to how medicines were managed. Medicines Administration Records were completed appropriately. Staff had received recent medicines training and there was an improved oversight of how medicines were managed.
At this inspection, we found that the provider’s oversight of care visits and staff rotas had improved. We received mostly positive feedback from people and relatives regarding timeliness of care visits. The provider had recently introduced an electronic call monitoring system which enabled them to monitor all care visits. However, we identified that care staff were not always staying for the full duration of the care visit.
Since the last inspection, the provider had recruited three care staff, one of which at the time of inspection was providing care. We found that some improvements had been made to how the pre-employment checks had been carried out.
We found that care plans were person centred and reflected what was important to the person. Care plans provided appropriate guidance to enable staff to deliver person centred care in line with people's preferences.
We received positive feedback from people and relatives regarding the caring nature of staff and their overall experiences with the provider.
Staff received regular training, supervisions and an annual appraisal. The provider had oversight of staff training needs.
We found that improved systems were in place to monitor and check the quality of care provided. We received consistently positive feedback from staff regarding the management structure in place and the support they received. Managerial oversight of the service had improved since the last inspection. Good practice had been developed, but further time was needed for the service to demonstrate that the improvements that had already been made had been fully embedded and could be sustained.
The provider has demonstrated significant improvements and as the service is no longer rated as inadequate for any of the five key questions, it is no longer in special measures.
Skillcare Limited is a domiciliary care agency based in the London Borough of Barnet registered to provide personal care for people in their own homes who may need support around their physical or mental health and may have learning difficulties or dementia care needs. At the time of this inspection there were 36 people using the service. The majority of people's care was funded by the London Borough of Brent.
The service had a registered manager. In this report we will refer to this person as the ‘provider’. 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 previously inspected Skillcare Limited on 30 August 2017 and we identified repeated breaches of legal requirements in relation to safe care and treatment (Regulation 12) and good governance (Regulation 17).
At this inspection we found that although some improvements had been made to how the service assessed risks, the provider had failed to meet regulations in relation to safe care and treatment (Regulation 12) and good governance (Regulation 17). In addition, at this inspection, we identified breaches of regulation in relation to fit and proper persons employed (Regulation 19), staffing (Regulation 18) and a failure to display ratings (Regulation 20A). The service remains rated Inadequate and in special measures.
The provider did not ensure medicines were managed safely, Medicines Administration Records were not appropriately completed, contained gaps and were not updated to reflect people’s current prescribed medicines. The provider had not ensured staff were competent to handle and administer medicines.
We found that improvements had been made to how the service assessed risks to people associated with their care needs, however we found instances of identified risks not being assessed and risk assessments containing incorrect information.
There was insufficient staff effectively deployed to ensure people’s care needs were met. We found instances of people not receiving their visits as per their assessed care needs. The provider did not have systems in place to ensure care visits were monitored effectively. Some care visits were scheduled to run concurrently, overlapping or without sufficient travel time.
The provider did not ensure safe staff recruitment. Not all staff had undergone appropriate recruitment checks prior to working with vulnerable people or having access to people’s confidential information.
Care plans were for the most part person centred and detailed. However the provider had recently switched to a new electronic care planning system which meant that care plans had lost detail around people’s needs, likes and dislikes and life histories. We found instances of care plans containing incorrect and inaccurate information.
Most people told us that felt safe with staff from Skillcare. However some people told us of frequently changing staff meant that they felt less secure than they had done previously.
Records indicated that staff had received regular training and an induction. However, we found inconsistencies with how staff received supervision and an annual appraisal.
People had their care needs assessed prior to receiving service. However we found inconsistencies in the provider’s assessment process and important information obtained in the care assessment was not carried through to the persons care plan.
Most people told us staff were caring; however we were told if instances of staff not delivering care as per the person’s assessed care needs.
Complaints were documented and investigated as per the provider’s complaints policy.
New audits had been introduced to monitor the overall quality of the service, however they had failed to pick up issues identified at the inspection.
We received mixed feedback from people and relatives regarding the overall running of the service. Care staff spoke positively of the management team and the support they received.
The overall rating for this service is 'Inadequate' and the service remains in 'special measures'. We are taking action against the provider for failing to meet regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.
At this inspection we found improvements had been made in some areas of concern, issues with complaints had been addressed and the service was no longer in breach of requirements in this area. However, the service was still in breach of two legal requirements relating to safe care and treatment and good governance.
This inspection took place on 30 and 31 August 2017 and was unannounced. Skillcare Limited is registered to provide personal care for people in their own homes who may need support around their physical or mental health and may have learning difficulties or dementia care needs. At the time of this inspection there were 60 people using the service.
Registration requirements of this service state there should be a registered manager in place working at the service. There was a registered manager at Skillcare Limited at the time of the inspection. 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.
There were repeated errors in medicines administration, making it unclear whether people had taken their medicines and which placed them at risk of becoming unwell.
Some people’s personal risks were not assessed placing people at risk of harm because staff were not instructed how to minimise the risk. Where risk assessments were in place some had out of date or conflicting information in them making it unclear how the risk had been assessed and how it could be mitigated.
There was a safeguarding process in place and we saw records regarding what action had been taken. Staff knew how to report any concerns of abuse. We were concerned about the welfare of one person who used the service and made a safeguarding referral to the local authority as it was not clear that their needs were being adequately met.
People said they felt safe and staff were using gloves and aprons to manage the spread of infections. Relatives said lateness had improved and two care staff came when they were needed.
The system for tracking late and missed care calls was still not fully functioning and there were some recording inconsistencies showing missed and late calls were still not being tracked effectively.
Some new audits had been introduced to check the quality of care but these had not picked up on the issues we found in risk assessments and MAR charts which showed an ongoing lack of oversight. Systems and processes were not in place where they were needed to check when reviews were due.
Staff received in house training and said they found the refresher training helpful. Regular supervision was taking place for staff to enable them to do their jobs more effectively.
People and relatives said care staff were kind and caring and did extra things that made a positive difference to them. Care staff were aware of how to treat people with dignity and respect.
We saw an improvement in how complaints were recorded and responded to. Some care files were person centred while others did not describe people’s preferences or likes and dislikes regarding their care.
Some new audits had been introduced to check the quality of care but these had not picked up on the issues we found in risk assessments and MAR charts which showed an ongoing lack of oversight. Systems and processes were not in place where they were needed to check when reviews were due.
This service is rated Inadequate in two key questions and therefore will remain 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 any concerns found during inspections is added to reports after any representations and appeals have been concluded. We are considering what action to take.
At the last inspection, we found that although the service had made improvements they were not sufficient, and there were three breaches of regulations in relation to safe care and treatment, acting on complaints and good governance. The provider sent us an action plan stating what improvements they were going to make. During this inspection we found that the provider had not made adequate improvements in relation to safe care and treatment, acting on complaints and good governance.
Skillcare Limited is a domiciliary care service providing personal care and support to people with a learning disability or autistic spectrum disorder, younger people and older people in their own homes. At the time of our inspection Skillcare Limited was providing care to over 60 people in their own homes in the London boroughs of Barnet, Brent and Enfield.
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.
We found numerous service failures; missed visits were still not recorded and lateness was still identified as a significant problem by many people who used the service and their relatives. There were several occasions where only one staff member arrived at care visits that required two staff. The electronic call monitoring system was still not working effectively and was causing staff scheduling errors. The service continued to maintain manual staff rosters but not all of them had care visit times which did not help in monitoring care visits. The service did not always keep staff rosters in the office for all geographical areas. This meant the information was not always accessible thereby risking the service to people in those areas being disrupted when there were staff emergencies and absences.
We found that the provider had not made sustainable improvements in their auditing processes. The audits that were carried out had not been effective as they did not always identify errors and gaps in daily care records, medicines administration records (MAR), and quality assurance records. People’s care plans and risk assessments were not always reviewed and updated following a change in the person’s needs or after accidents and incidents. The audits did not always pick up on the inconsistencies in practices and care delivery. The service did not promptly act to reduce risks following unsafe moving and handling and infection control practices that were identified during quality assurance process. The service did not always identify risks involved in care delivery thereby putting people and staff at risk of harm.
Risk assessments were detailed but did not always include appropriate information on the management of the risks to people from ongoing health conditions. The service did not always appropriately record medicines given on MAR. Accident and incident forms did not always record the learning gained from them or the actions taken.
Staff were checked and assessed for the quality of the care provided via spot checks; these are checks that are carried out by office staff to identify if staff provided care as per care plan and arrived on time; however additional checks were not always carried out in response to concerns about staff members. Complaints identified during spot checks and through quality assurance processes were not always recorded and investigated appropriately. People told us that concerns reported to the office were not always addressed and there reoccurrences.
The provider recorded the capacity of people to consent to the care and treatment but there were gaps in consent to the care and treatment forms.
Staff demonstrated a good understanding of protecting people against abuse and their role in promptly reporting poor care and abuse. However, the service did not implement required infection control practices.
The provider generally followed appropriate recruitment procedures. Staff continued to receive regular supervision. Most staff received induction and training to provide care effectively.
People and their relatives told us they felt safe with staff and were happy with them. They said that staff were friendly and caring, and respected their dignity and privacy. Most people were happy with the support they received around nutrition and hydration needs. People were asked their views on the quality of their care.
We found that the provider was not meeting legal requirements and there were overall three repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, acting on complaints, and for systems and processes to improve the quality of the services including accurate records. The service remains in ‘Special Measures.’
You can see what action we told the provider to take at the back of the full version of the report. However, full information about our regulatory response to the concerns found during this inspection will be added to this report after any representations and appeals have been concluded.
Skillcare Limited is a domiciliary care service providing personal care and support to people with dementia, mental health needs, a physical disability, learning disability or autistic spectrum disorder, sensory impairment and older people in their own homes.
The service had a registered manager. 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 found that the provider had made improvements in their auditing processes since they were last inspected, however these had not been sufficient to pick up errors in care delivery records which did not always reflect the agreed care plan. The audits did not always pick up on the inconsistencies and gaps in the records, practices and care delivery. The care plans were personalised and regularly reviewed. We found that risk assessments were detailed and individualised but did not always include sufficient information on the management of the risks to people from ongoing health conditions. There had been improvements in medicines assessments, however we found that medicines given were not always appropriately recorded on medicines administration records (MAR) charts and care plans. The MAR charts did not have appropriate information for staff to follow to ensure safe management of medicines. In some cases care plans did not document the support people received with their medicines appropriately. People were happy with the support they received around nutrition and hydration needs.
We found there was an improvement in the punctuality of care visits, however some missed visits were still recorded and lateness was still identified as a significant problem by many people who used the service and their relatives. In addition to this the electronic call-logging system was not working effectively and was causing staff scheduling errors. The service maintained manual staff rosters but were not recording care visit times on them which did not help in monitoring care visits.
We found the service followed appropriate safeguarding procedures and staff demonstrated a good understanding of protecting people against abuse and their role in promptly reporting poor care and abuse. The service implemented required infection control practices.
The provider followed appropriate recruitment procedures and staff were checked and assessed for the quality of the care provided via spot checks; however additional spot checks were not always carried out in response to concerns about staff members. Staff received regular one-to-one and group supervision and appraisal which was an improvement from the last inspection. Staff received induction and training to provide care effectively.
Complaints were recorded and investigated appropriately in line with the provider's policies, however people told us that concerns reported to the office were not always addressed and there were reoccurrences.
The provider recorded the capacity of people to consent to their care and treatment and where they were unable to confirm detail if relative’s held the Power of Attorney. However, the information was recorded in different places in the care plans creating confusion.
Most people we spoke with were happy with their care staff, and said that staff were kind, friendly, caring and respected their dignity and privacy. We saw that staff were reporting when they were concerned about people's health and welfare, and that appropriate steps were taken in these cases. People were asked their views on the quality of their care, and care packages were reviewed regularly.
Local authority acknowledged the developments within the service since last inspection however, stated that it still needed further improvement.
We found that the provider was not meeting legal requirements and there were overall six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, acting on complaints, record-keeping and systems and processes to improve the quality of the services.
You can see what action we told the provider to take at the back of the full version of the report.
We have made a recommendation that the service seeks advice and guidance regarding appropriately capturing and recording information on MCA and DoLS, based on current practice.
The overall rating for this service is ‘Requires Improvement’. At the last comprehensive inspection this provider was placed into special measures by CQC and conditions were put on their registration requiring the provider to report to CQC monthly on the audits carried out. This inspection found that there was not enough improvement to take the provider out of special measures.
The service 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.
Skillcare Limited is a domiciliary care service that provides personal care, housework and assistance with medicines to over 70 people with learning disabilities, older people and younger adults in their own homes.
The service had a registered manager who has been registered with the Care Quality Commission. 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.
People and relatives told us staff listened to them and their health and care needs were met. People and relatives told us they found staff caring and helpful. Staff were able to demonstrate their understanding of people they cared for their needs and preferences. People’s privacy and dignity were maintained.
We checked medicines administration charts and found that clear and accurate records were not being kept of medicines administered by staff. Care plans and risk assessments did not support the safe handling of some people's medicines. There were incomplete care plans, risk assessments and care records.
There were safeguarding policies and procedures in place. However, staff were not able to demonstrate their role in making safeguarding alerts and raising concerns. Staff lacked understanding of the threshold of safeguarding and the role of external agencies.
There were inconsistencies in staff receiving appropriate and necessary support and supervision; we could not evidence records of staff supervision. Staff told us they attended induction training and additional training however, there were gaps in the training records.
The service was not following their recruitment and selection policy and procedures, safe recruitment procedures were not being followed. Not all staff files had records of application form, interview assessment evidence, criminal record checks and reference checks. References were not always validated by company stamp or headed paper, some references had address details missing.
The service did not have effective systems and process in place to assess, monitor and improve the quality and safety of service provided. There were no evidence of regular monitoring checks of the quality and safety of the service.
We found that the registered provider was not meeting legal requirements and there were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
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.
CQC is now considering the appropriate regulatory response to resolve the problems we found.
People who used the service had been assessed and their choices and preferences were noted. Risk assessments had been prepared. Care plans had been prepared with the involvement of people who used the service and their representatives. Staff we spoke with were aware of the needs of people and the care to be provided. The care provided was closely monitored by the manager.
The agency had an appropriate recruitment policy and procedure. There was evidence that staff had been carefully recruited. The recruitment records contained references, criminal records disclosures and other essential documentation.
The agency had a policy and procedure for safeguarding adults. Care staff could provide examples of what constituted abuse and knew how to respond to allegations or incidents of abuse.
There were arrangements for quality assurance. Satisfaction surveys, monitoring visits and spot checks had been carried out by the manager. The results of a recent survey indicated that people who responded were satisfied with the services provided.