Background to this inspection
Updated
26 April 2023
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
The inspection was carried out by an inspector, a pharmacist specialist inspector, a medicines inspector and an Expert by Experience who conducted telephone calls with people using the service and their relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses, flats, and specialist housing.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave a short period notice of the inspection. This was to ensure the registered manager was available to support the inspection and allow the provider time to start asking people using the service and their relatives if they would be prepared to speak to us about their experiences. Inspection activity started on the 7 March 2023 and ended on 17 March 2023, by which time we had sought the views of people, relatives and staff and reviewed all additional information sent following the visit. We conducted office visits on the 9 and 13 March 2023.
What we did before the inspection
We reviewed information we had received about the service since it was registered. This included notifications sent to us by the home. Notifications are changes, events, or incidents the provider is legally obliged to send to us without delay. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.
During the inspection
We spoke with 6 people using the service and 6 family members about the experiences of the care provided. We visited 2 people in their homes to speak to them and/or their relatives and look at medicines. We spoke with the registered manager, 2 quality assurance officers and 2 care staff in person and sought the views of 1 care staff via a telephone call and 10 care staff via emailed questionnaires, 7 of whom responded.
We reviewed a range of records. This included 5 people’s care records and 9 people’s medication records. We looked at 6 staff files in relation to recruitment, training, and support. A variety of records relating to the management of the service were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We also reviewed various policies and procedures and medicine records, as well as seeking staff feedback.
Updated
26 April 2023
About the service
Greater Manchester, known by people using the service as Rings Homecare, is a domiciliary care service based in Bolton, Greater Manchester. The service is registered to provide care and support to children, younger and older adults living in their own homes.
Not everyone who used the service received personal care. The Care Quality Commission (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 inspection, 42 people received personal care and were included in the inspection.
People’s experience of using this service and what we found
We found improvements were required with medicines management, record keeping and the audit and governance process. Record keeping and documentation relating to people’s medicines was not always completed fully, accurately or in line with the provider’s policy. The provider’s audit process had not identified the issues we noted on inspection.
People and relatives we spoke with, told us the service provided safe care. Staff had completed training in safeguarding and knew how to report concerns. Care staff completed their visits on time and remained for the full length of the call. New staff had been recruited safely, with all necessary safety checks completed. Risks to people had been assessed, with information in care plans on how these would be minimised as much as possible.
People and relatives told us they were happy with the service, and most would recommend the company to others. People’s views had been sought through telephone reviews with either themselves or their next of kin. Everyone we spoke with told us communication with and from the service was good. Staff’s views were also sought through regular meetings and surveys.
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 4 October 2022) 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 the provider remained in breach of regulations.
Why we inspected
We carried out a focused inspection of this service in August 2022. Breaches of legal requirement were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.
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 and Well-Led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection (published January 2020) to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
We have found evidence the provider needs to make improvements. Please see the safe 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 Greater Manchester on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to medicines management and the audit and governance process at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.