Your Choice 4 Care

Updated 27 August 2021

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 Care Act 2014.

Inspection team

The inspection was completed by one inspector and one inspection manager.

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 service had a manager 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 24 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 28 June 2021 and ended on 16 July 2021. We visited the office location on 28 June 2021.

What we did before the inspection

We looked at information sent to us since the last inspection such as notifications about accidents and safeguarding alerts. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We sought feedback from the local authority safeguarding and contracting teams. We used all of this information to plan our inspection.

During the inspection

We spoke to four members of care staff and the provider who was also the registered manager. We also spoke with two people who used the service and four of their relatives about their experience of the care provided.

We reviewed a range of records. This included the care records of four people including care plans, risk assessments, medicines records, daily care records and call monitoring records. We looked at two staff files in relation to recruitment, training and their competency in their role. We also reviewed a variety of records relating to the management of the service, including policies and procedures.

After the inspection

We reviewed further information regarding medicines, audits and policies. We also received feedback from two professionals who worked closely with the service.

Updated 27 August 2021

About the service

Your Choice 4 Care is a domiciliary care agency providing personal care and support to people 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 the inspection, the service was supporting 8 people, 6 of whom were receiving personal care.

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

There was an increase in governance and oversight since the last inspection. Governance systems had improved the safety of the service through appropriate inductions, training, competency and spot checks. Risk assessments were in place with care plans having detailed guidance in place to support staff to meet people’s needs.

Although there was increased oversight of the service, we continued to identify issues with medicine records, staff recruitment and competency records, late calls and lack of accident and incident monitoring systems. Further work was required to fully address concerns we identified at the last inspection.

Some medicines records were not always accurate. This placed people at risk of having their medicines administered incorrectly.

People were positive about the support from staff and their caring approach. Most people felt communication had improved if staff were going to be late. However, it was acknowledged that care staff were still late. The provider had not taken identified or taken action to address continued late calls.

Improvements had been made to the processes in place for infection prevention and control. Staff had a better understanding and knowledge of government guidance in relation to personal protective equipment.

The registered manager was completing daily checks of records and monitoring records showed shortfalls were being addressed with staff. Staff confirmed any shortfalls regarding logging in, content of daily records and not completing daily notes was followed up with them straight away.

People and staff had completed questionnaires about their experiences of the service. Further collation of responses and analysis had yet to be created.

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 17 March 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 17 March 2021. 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 focused inspection of this service on 21 December 2020. Breaches of legal requirements were found. We issued a Warning Notice and placed conditions on the providers registration. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm whether the conditions on registration and the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Key Questions safe 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 has changed from Inadequate to 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 Your Choice 4 Care 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 monitor the service 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 medicines and governance systems 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 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.