Careville Limited

Careville Limited is a domiciliary care agency providing personal care to people living in their own homes or flats. At the time of the inspection, the service provided support to two 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 supported in a consistently safe manner. Risk assessments did not provide clear guidance for staff to reduce identified risks. The registered manager had supplied an action plan after the previous inspection. However they had failed to make the necessary improvements to ensure that care was delivered in a safe and effective manner.

Medication administration records (MAR) and daily records were not always completed accurately. This meant it was not clear if people had received the required level of care to keep them safe.

Staff pre-employment checks had not been completed. This meant the provider had not checked staff suitability to support people. This was an area requiring improvement which the provider had previously been told to take action but had failed to do so.

There was a lack of provider oversight and management at the service. The registered manager had failed to recognise their responsibility to ensure the delivery of care was of a high quality and safe. The quality assurance processes in place were not robust and did not drive improvements in the service.

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 support this practice. Care records did not clearly detail if people had capacity or how staff should support them in making decisions.

Staff had received COVID-19 training. Relatives told us they felt assured by staff who were observed wearing appropriate personal protective equipment (PPE). This included facemasks, gloves, aprons and face visors.

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 8 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been rated as requires improvement for the last two consecutive inspections.

At this inspection we found the provider had not made improvements and was still in breach of regulation.

Why we inspected

We carried out an announced comprehensive inspection of this service on 20 June 2019. 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 management of safety risks and recruitment processes.

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.

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 remains 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 Careville 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 safe care and treatment; fit and proper persons employed and good governance.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Careville Limited is a domiciliary agency providing personal care and support to one person at the time of the inspection. 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 safe as the provider had not identified all risks. For the risks the provider had identified, measures to minimise harm were not sufficient. The provider had not ensured all references were satisfactorily returned and gaps in staff employment history checked prior to them starting work. The registered manger did not provide a sufficient induction process to ensure staff knew how to safely support people. This meant the provider had not checked staff were suitable to support people who received the service, placing people at risk from harm.

People received appropriate support with medicines where needed. The provider reduced this risk by providing staff with training in safeguarding and staff showed a good understanding of how to keep people safe from abuse and how to report concerns.

Staff supported people 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 support this practice. Records were unclear in regard to whether or not people had capacity to make their own decisions. However, people were supported to do so in practice.

Choices people had included food and drink preferences and how they wanted care carried out. The provider assessed people’s wishes and needs and held regular reviews. The provider worked with other health and social professionals and private agencies to ensure they delivered consistent care.

Staff spoke about people with kindness and patience and people were supported to review their care through regular telephone and face to face conversations as well as reviews of care needs. People were supported to maintain as much independence as possible. The nominated individual was able to show an in-depth knowledge of the person’s needs, personal history and likes and dislikes.

Staff provided care that was in line with people’s personal preferences and care plans showed detail in relation to peoples need. This meant staff had a good knowledge of how to support people in ways they preferred. The provider was not supporting people receiving end of life care currently, but the provider had advanced care plans and training ready if needed. Complaints processes were available, and people and their relatives understood how to raise a concern.

The registered manager and provider saw or spoke to people regularly. However, the provider did not always record them conversations, meaning that some updates could be lost.

We have made a recommendation about ensuring best practice for staff induction, development and support. We have also made a recommendation about ensuring clear records to evidence a person’s capacity to make their own decisions.

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

Rating at last inspection

This service was registered with us on 07 August 2018 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of registration.

Enforcement

We have identified breaches of regulations due to not ensuring safe pre-employment checks were completed prior to staff starting work; failing to ensure risks were identified and safely managed and lack of good management of the service.

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 speak 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.