Background to this inspection
Updated
8 April 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008
Inspection team
One inspector completed the inspection.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The provider is also the manager and is registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 17 February 2022 and ended on 7 March 2022. We visited the location’s office on 17 February 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection.
We spoke with three members of staff, which included the provider.
We reviewed a range of records. We looked at a variety of records relating to the care and support provided, three staff files in relation to recruitment and various audits/reports relating to the quality and safety of the service to ensure people received safe care and support specific to their individual needs. We requested a variety of records were sent to us relating to staff training and regards the management of the service.
After the inspection
After our visit we sought feedback from people using the service, relatives, staff and health and social care professionals to obtain their views of the service provided to people. We received feedback from three people using the service, one relative, three staff and four health and social care professionals. We continued to seek clarification from the provider to validate evidence found. We provided initial feedback to the service on 7 March 2022.
Updated
8 April 2022
About the service
Charity Earnshaw is a domiciliary care service, supporting adults in the community who require assistance with personal care. This included people living with dementia, physical disabilities, mental health needs and sensory impairments. 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 our inspection there were seven people using the service.
People’s experience of using this service and what we found
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.
At our previous inspection in April 2021 the provider did not have adequate systems in place to monitor and review the quality of care and ensure the service was meeting people’s needs safely and effectively. At this inspection this was no longer the case. Following our inspection in October 2020 positive conditions were place on the provider’s registration. Since this inspection CQC have received monthly documentation and audits from the provider.
The provider continued to act on feedback, advice and guidance from relevant health and social care professionals. They had a comprehensive on-going service improvement plan in place to continually strive to provide people with a safe and good quality service. The provider had continued to engage an external consultant to support them with this.
Systems were in place to monitor the quality and safety of the service. This included a comprehensive range of audits; observations and quality assurance questionnaires. Audits were completed on a regular basis as part of monitoring the service provided. Where actions were needed, these had been followed up. For example, care plans and risk assessments updated.
We discussed with the provider about their plans to grow the service. They explained that they would be taking on new packages of care slowly in order to test out their systems and processes to ensure they are robust enough and embedded in practice.
At our previous inspection in April 2021 risk assessments were not always consistent or accurate, which placed people at harm. At this inspection this was no longer the case. Risk assessments contained clear and detailed guidance for staff about how to minimise risks and were consistently in line with people’s care and support needs. For example, to mitigate risks around continence care, falls, nutrition and hydration and diabetes management.
Information in risk assessments correlated with that of people’s care plans and daily notes. Care plans contained information in line with and addressed people’s assessed risks, and how to reduce or prevent them. This enabled clear oversight and enabled changes in a person’s physical or mental health to be escalated to relevant health and social care professionals.
There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. The provider worked proactively with relevant health and social care professionals and acted upon feedback, guidance and advice to ensure people received safe care and support in line with best practice guidance.
At our previous inspection in April 2021 the provider had failed to establish and operate effective systems to prevent abuse to people. At this inspection this was no longer the case. The provider had continued to be proactive in liaising with the local authority and Care Quality Commission making timely safeguarding referrals in a consistent way. The provider and their staff team demonstrated an understanding of their safeguarding role and responsibilities. There were clear policies for staff to follow.
At our previous inspection in April 2021 the provider had failed to holistically assess people’s needs and develop accurate care plans. At this inspection this was no longer the case. The providers systems to assess people’s needs and develop care plans were effective. The information in care plans consistently reflected the information in assessments.
People felt safe and supported by staff in their homes. Comments included, “I feel safe with my carers” and “I have absolutely no concerns about my carers keeping me safe.” Information was available for people on adult safeguarding and how to raise concerns.
Medicines were safely managed on people’s behalf. Staff had received training in infection control. This helped them to follow good hygiene practices during care and support. Everyone said staff were following good personal protective equipment (PPE) guidelines in relation to the COVID-19 pandemic.
There were sufficient staff to meet people’s needs. People confirmed that staffing arrangements met their needs. People confirmed staff always stayed the allotted time. Comments included, “My carers always turn up on time and stay the correct time” and “I usually have the same carer.”
There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.
Staff spoke positively about communication and how the provider worked well with them and encouraged their professional development.
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 June 2021) 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 3 December 2020. 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
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, Effective and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. 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 Charity Earnshaw on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.