Care @ Home Newbury Ltd

Care @ Home Newbury LTD is a domiciliary care agency providing personal care to people in their own homes. The service provides support to older people, people living with dementia and people with a physical disability. At the time of our inspection the service was providing personal care to 24 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.

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

Medicines were not managed safely. Care plans did not contain sufficient and detailed guidance for staff to enable them to provide individualised care for people.

There was a lack of evidence of mental capacity assessments having been completed for people where information indicated people may not have the capacity to consent to receiving different aspects of care and support.

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; however, the policies and systems in the service did not always support this practice.

There was a lack of evidence to show plans were in place to support people in their last days.

Although the provider had made improvements in governance and leadership some additional work was needed to ensure continuous and sustained improvement.

People were involved in planning their care and support and were encouraged to express their views on the care and support provided. The provider maintained a log of concerns and complaints which showed actions were taken by staff when concerns were raised.

People, staff and people’s representatives were involved in how the service was run. The provider supported staff to learn through supervisions, spot checks, competency observations and staff meetings. The provider worked in partnership with external professionals to help meet people’s health and wellbeing needs.

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 29 July 2022) and there were 8 breaches of regulations.

We served a warning notice against the provider and issued seven requirement notices. 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 the provider had complied with some regulations but remained in breach of other regulations.

This service has been in Special Measures since 29 July 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

We carried out an announced, comprehensive inspection of this service on 29 July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety of people, the effectiveness of care and ensure the service was well-led.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm whether they now met legal requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Care@Home Newbury LTD on our website at www.cqc.org.uk.

We have found evidence the provider needs to make further improvements.

Enforcement and Recommendations

We have identified continued breaches in relation to person centred care, consent, safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will also continue to meet with the provider to discuss their progress towards achieving compliance with the regulations.

Care @ Home Newbury LTD is a domiciliary care agency providing personal care to people in their own homes. The service provides support to older people, people living with dementia and people with a physical disability. At the time of our inspection the service was providing personal care to 24 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.

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

People were not always protected from the risk of harm or abuse. There were no records of staff training in safeguarding. The provider had not notified us of an allegation of abuse by a staff member against a person using the service. The provider did not have records of safeguarding referrals. The provider was not able to evidence there were enough suitably trained staff available to provide safe care for people. Recruitment files did not contain all of the required information. Medicines were not managed safely. There were no records of incidents and accidents and no evidence of lessons learned by staff.

Care plans did not contain sufficient guidance for staff to enable them to provide individualised care for people. Staff did not receive supervision. There were no records of staff working with professionals to meet people’s health and wellbeing needs.

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.

People were not enabled or supported to express their views on care and support provided. There was no evidence to show people were involved in making decisions about their care and support.

There was no record of complaints or concerns received by the provider. There were no records of plans in place to provide compassionate care and support to people at the end of their lives.

There were widespread and significant shortfalls in governance and leadership. The provider did not use any systems or processes to monitor and improve quality and safety in the service. People, staff and the public were not involved in how the service was run. The provider did not support staff to learn through reflective practice. There were no records of staff working in partnership with other agencies and professionals.

Staff treated people with kindness and compassion. They promoted people’s dignity and privacy.

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 good (published 18 November 2019)

Why we inspected

We undertook a focussed inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing and governance. A decision was made for us to inspect and examine those risks.

We inspected and found there were also concerns about assessments of people’s needs, records of staff’s interactions with professionals, records of people’s consent to care and treatment and mental capacity assessments, records of staff support and training, evidence of people being included and involved about decisions about their care, and records of concerns and complaints. We widened the scope of the inspection to become a comprehensive inspection which included the key questions of safe, effective, caring and responsive and well led.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections at the end of this report.

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

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care @ Home Newbury LTD 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 person centred care, consent, safe care and treatment, safeguarding service users from abuse, investigating and responding to complaints, good governance, staffing, notifications of other incidents and fit and proper persons employed 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Care @ Home Newbury Limited is a home care service providing personal care to people in their own homes. At the time of our inspection there were 13 people receiving personal care services.

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

People received care and support that was safe. The provider had arrangements in place to protect people from risks, including the risk of abuse or avoidable harm. There were effective recruitment processes in place to make sure staff employed were suitable to work with people in their homes. Systems were in place to promote safety around medicines and infection control.

People received care and support that was effective and based on thorough and detailed assessments and care plans. Staff had support and training to deliver care according to people’s needs. The provider worked with other agencies to deliver consistent and effective 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.

People had caring and kind relationships with their care workers and the registered manager. The provider worked to respect and promote people’s privacy, dignity and independence by encouraging people to be involved in their care.

People received care and support which met their needs and reflected their preferences. The provider complied with best practice guidance with respect to people’s communication needs.

The service was well led. There was a focus on meeting people’s individual needs, respecting their choices and preferences, and effective and frequent communication. This was supported by a management system appropriate for the size of the organisation.

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

Rating at last inspection

The last rating for this service was good (published 13 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

This inspection took place on the 22 November 2016 and was announced.

Care @ Home Newbury Ltd is a domiciliary care agency which provides staff to support people in their own homes. People with various care needs can use this service including people with physical disabilities and older people. At the time of this inspection 14 people received care from this service.

At the last inspection on 5th August 2014 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as requires improvement in areas such as ineffective recruitment procedures, lack of assessment and monitoring of the quality of the service and appropriate training and supervision of staff.

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.

People and their representatives told us that they felt safe with staff and would be confident to raise any concerns they had. The provider’s recruitment procedures were thorough and medicines were managed safely. There were sufficient staff to provide safe, effective care at the times agreed by the people who were using the service.

There were procedures in place to manage risks to people and staff. Staff were aware of how to deal with emergency situations and knew how to keep people safe by reporting concerns promptly through processes that they understood well.

Staff received an induction and spent time working with experienced members of staff before working alone with people. Staff were supported to receive the training and development they needed to care for and support people’s individual needs.

People and their families were mostly complementary about the services provided. The comments we received demonstrated that people felt valued and listened to. People were treated with kindness and respect whilst their independence was promoted within their homes and the community. People received care and support from familiar and regular staff and would recommend the service to other people.

People’s needs were reviewed regularly and their care and support plans promoted person-centred care. Up to date information was communicated to staff to ensure they could provide the appropriate care and support for each individual. Staff knew how to contact healthcare professionals in a timely manner if there were concerns about a person’s wellbeing.

The provider had a system to regularly assess and monitor the quality of service that people received and identified areas for improvement.

The provider had implemented a new recruitment policy to ensure that their recruitment procedures met legal requirements.

We saw that the service had a system for identifying risk in relation to the care people received. Care plans contained risk assessments.

We found the service had undertaken appropriate checks on a new member of staff before they began work. The service provided a new member of staff with an induction which included experience in caring for people who use the service alongside an experienced care worker. The service provided the new member of staff with training to ensure they had the skills necessary to care for people safely.

The service had implemented monitoring systems since our last inspection. The service had completed analysing results from a survey on people who use the service. There was a training monitoring system in place. People and staff told us the manager asked them for their feedback and considered people's opinions in how to improve the service.

We found the service's system for identifying, assessing and managing risks related to the care people received was inadequate. People were not protected from the risks of inappropriate or unsafe care.

Although people we spoke with were satisfied with the service and response to people's care needs, they said there was no periodic monitoring of the care they received and they were not aware of a process by which they could provide feedback.

We saw the quality monitoring folder however this contained no recent documents on the monitoring of the service or recent feedback from people who use the service.

Staff files contained relevant information regarding recruitment and some training certificates. However not all the information required under Schedule Three was available.