Jaysh Care Services

Jaysh Care Services is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 44 people with personal care needs at the time of our inspection. 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.

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

People did not always receive a service that provided them with safe, effective, compassionate and high-quality care.

People were at risk of harm because staff did not always have the information, they needed to support people safely. Medicines were not managed safely.

The provider did not have enough oversight of the service to ensure that it was being managed safely and that quality was maintained. Quality assurance processes had not identified all the concerns in the service and where they had, enough improvement had not taken place. Records were not always complete. People and stakeholders were not always given the opportunity to feedback about care or the wider service. This meant people did not always receive high-quality care.

The service was not always well-led. Governance systems were ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not maximising people's choices, control or independence. There was a lack of person-centred care. We made a recommendation about this.

People and their relatives were not always supported to give feedback. We made a recommendation about this.

People were not always supported to express their views and make decisions about their care. We have made a recommendation about this.

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

Rating at last inspection

The last rating for this service was requires improvement (published 5 September 2019). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last three consecutive inspections.

At our last inspection we recommended the registered manager review the requirements under the duty of candour to ensure their knowledge and processes were up to date and fit for purpose. At this inspection we found the registered manager had acted on the recommendation and improved their understanding.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can see what action we have asked the provider to take at the end of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jaysh Care Services on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, medicines management, consent, support and training and governance at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

Jaysh Care Services is a domiciliary care agency providing personal care to people in their own homes. The service was supporting five people with personal care needs at the time of our inspection. 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.

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

At our last inspection on 31 January and 5 February 2019 Jaysh Care Services was rated Inadequate and we found multiple breaches of regulations. At this inspection we found significant improvements had been made. However, care was currently being provided to a small group of people and more time was required to embed and sustain these improvements over a longer period to ensure people were cared for safely.

People told us they received safe care. The registered manager had made improvements in the risk assessment of people’s needs and the management of their medicines. Some records required further detail and updating. Staff understood how to support people safely, were safely recruited and knew how to safeguard people from abuse. People were protected from the risk of infection. People told us they were satisfied with the management of their care calls and enough staff were available to meet their needs. Incidents and accidents were reported by staff and actions were taken to prevent a reoccurrence.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, it was not evident the Mental Capacity Act (2005) had always been applied to decision making. Further improvements were required, and we have made a recommendation about this. Staff completed training to meet people’s needs and staff competency was checked. Staff were supported through supervision, appraisal and observed spot checks. Improvements had been made in the delivery of people’s care to reflect current legislation and guidance. People’s healthcare needs were monitored, and they were supported to access healthcare services when needed.

People and their relatives told us staff were kind and caring. Staff knew how to provide respectful care that promoted people’s dignity and privacy. People told us they were involved in decisions about their care and these were respected by staff.

The registered manager was in the process of developing the service approach to end of life care through staff training and care planning. Care plans demonstrated people had been asked about their preferences and needs, and people told us their needs were met. People and their relatives were aware of how to complain and the registered manager had procedures in place to manage complaints effectively. People were asked about their communication needs and the service was able to support people’s needs for alternative formats should this be required to understand information.

Since our last inspection in January 2019, improvements had been made in the quality and safety of the service people received and this was being embedded into practice. An effective system was now in place to monitor the service and to achieve continuous improvements. The registered manager had improved their knowledge of their regulatory responsibilities, however their knowledge of the duty of candour was limited. We have made a recommendation about this. People and staff spoke positively about the changes in the service and told us their needs were met. Staff told us the culture was positive and they were clear about their roles and responsibilities.

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 14 March 2019) and there were multiple breaches of regulation. This service has been in Special Measures since 14 March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jaysh Care Services on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider and local authority to monitor progress. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

•People told us they felt safe using the service. However, despite people’s positive comments, we found that care was not always delivered safely. People’s medicines were not managed safely, risks to people had not been fully assessed and plans to mitigate risks were not in place. Staff had not been trained or assessed as competent to safely meet all the needs of the people they supported. Staff had not been recruited safely and incidents that posed risks to people had not been identified and acted on promptly or appropriately to safeguard people from the risk of abuse.

•The registered manager and company secretary were delivering care due to the shortage of care staff employed. This meant people could not always receive their care at their preferred times but people we spoke with accepted this. Due to these arrangements the registered manager did not have sufficient time to attend to the governance of the service and this had meant ongoing concerns about the quality and safety of the service had not been addressed in a timely manner.

•People’s care records were not always person centred, accurate or up to date and the arrangements in place for people’s consent to care was not always clear.

•Complaints received had not been investigated or acted on without delay, to prevent a reoccurrence of the failing and mitigate risks to people from unsafe care.

•The registered manager did not have effective systems in place for identifying and managing risks to the quality of the service. This meant that people had been exposed to harm from unsafe care, and that risks to people were ongoing.

•We received positive feedback about the care provided by the registered manager and most of the care staff. People and some people’s relatives were appreciative of the flexible approach taken by the service which had enabled them to have the care arrangements they chose.

Rating at last inspection: This was our first inspection of this service which was registered on 12 May 2018.

Why we inspected: This inspection was brought forward in our planned inspection schedule due to information of concern we received from the local authority.

Follow up: A number of breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified during the inspection. The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider's registration of the service, it 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 act 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. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good