Archived: Connected Health Plus

Connected Health Plus is a domiciliary care agency providing personal care to people living in their own homes. At the time of this inspection the service was supporting 49 people with personal care. 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 received their medicines safely and as prescribed. Staff had received training on this topic and their competency was regularly checked. Record keeping in this area had significantly improved since the last inspection and the provider had implemented quality assurance processes to check people were receiving their medicines safely.

Overall, the punctuality and duration of people’s calls had improved since the last inspection and this was reflected in people’s feedback. One person said, “At the moment, since about June or July, it’s been a million times better and they’re keeping to four times a day now.” However, there were still some examples of variations in people’s scheduled call times and durations and their actual times and duration. One person commented, “They’re still often late and seem to have a steady stream of excuses.” Staff rotas were both safer and more manageable since the last inspection and staff were no longer working excessive hours in order to cover calls. Staff were safely recruited by the service.

People and relatives said they felt safe with the staff. One person commented, “I feel absolutely safe because of their professionalism and their skills. All have been above and beyond.” The provider had systems in place to safeguard people from the risk of abuse. Staff had received safeguarding training and understood their role and responsibilities managing safeguarding concerns.

People and their relatives told us staff always wore the required personal protective equipment (PPE) when supporting them. Staff had received training on infection prevention and control and used personal protective equipment (PPE) in line with the national guidance. Some staff had been taking a lateral flow tests (LFTs) twice-a-week rather than a weekly polymerase chain reaction (PCR) test as per the national guidance for care at home services. The provider took immediate action during our inspection to ensure all staff were carrying out the correct type of test, clarifying that LFTs were supplementary to the required weekly PCR test.

People and their relatives were able to give feedback about their care. They spoke positively about the way staff had engaged with them and responded to any concerns they had since our last inspection. Comments included, “They’re very nice and you can speak to them, they’ve really improved. I do get questionnaires asking about my views” and “Communication is excellent. I know where I am with them. We have a good rapport and trust. It’s easier to call the contact number for the office now.”

The provider had improved its quality assurance processes since our last inspection. However, further improvements were required to improve the robustness and efficacy of some aspects of these processes. The culture amongst staff at the service had improved. There was an increased focus and ability to provide people with safe and effective care that met their 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 3 September 2021) 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 3 September 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 unannounced comprehensive inspection of this service on 24 and 28 June 2021. 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 address the multiple breaches of regulations.

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 inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Follow up

We will work alongside the provider and local authorities to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Connected Health Plus is a domiciliary care agency providing personal care to people living in their own homes. At the time of this inspection the service was supporting 163 people with personal care. 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 receive their medicines safely and as prescribed. Examples included, medication to manage diabetes, epilepsy, blood thinners and antibiotics. The provider did not have clear information or understanding of people’s individual medication needs. Medicines administration records (MARs) were poorly maintained and not in line with best practice.

Staffing levels and rota systems were unsafe. People’s calls were significantly late, early, short or missed. People and their relatives told us staff were often late or missed calls completely. One relative commented, “The morning visit is scheduled for 10am, [staff] come at 1:30pm in the afternoon, so missed breakfast, lunch and medication.”

People were not safeguarded from the risk of abuse, particularly neglect, due to late, early, short and missed calls. People and their relatives were unable to rely on the service to provide the essential care and support they needed when they needed it. One relative commented, “[Provider] is so unfit for purpose. [The staff] are meant to give [Relative] sandwich on plate, quite frequently goes without. We’ve observed staff pop head in then leave without giving [Relative] medication or lunch, no pad changed or bedding changed.”

The provider’s systems to assess, monitor and improve the quality and safety of service being provided were inadequate. Senior staff and governance systems had not recognised or responded to the significant and widespread issues we identified during this inspection. A poor culture had developed at the service. Shortcomings in care, poor practice and a failure to meet people’s needs were not always challenged but accepted. CQC had not been notified of all significant events which had occurred, in line with the registered provider’s legal obligations.

People and their relatives told us staff rarely responded or returned their calls when raising concerns about their care and call times. Staff told us they did not feel supported by the provider and had to work excessive hours to complete all their calls.

There was extensive call-cramming meaning staff were scheduled to be at multiple calls at the same time and/or back-to-back calls without any time for travel. The provider’s approach to call cramming meant it was inevitable and obvious people’s care needs would not be safely and effectively met or not met at all. The provider’s electronic call data demonstrated clear and widespread evidence of significantly late, early, short and missed calls. However, no action was taken to recognise the seriousness of the situation or seek support from other stakeholders.

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 21 April 2021).

Why we inspected

We received concerns in relation to late and missed calls, the management of medicines and a lack of leadership and governance processes. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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 the safe management of medicines, safeguarding people from abuse, good governance, staffing.

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

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.

Connected Health Plus is a domiciliary care agency providing personal care to people living in their own homes. At the time of this inspection the service was supporting 82 people with personal care. 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 and their relatives told us staff usually came at the agreed times and were able to spend time chatting with people. Comments included, “They [the staff] are all regular they come four times-a-day and are on time. If they are delayed, they let us know” and “Within the half hour they [the staff] have time to talk to you and discuss everyday things.” Records we reviewed showed people usually received their calls at the times they had requested and agreed. The provider had effective processes in place to investigate and resolve occasions when call times had differed from the planned times. Staff rotas did not always allow enough time for travel between calls. Therefore, we have made a recommendation about the provider’s approach to staff rotas.

Records we reviewed showed people had received their medicines safely and as prescribed. One relative said, “Staff give [Relative’s] medication, they encourage [Relative] to take it and wait by [Relative’s] side.” The provider had systems and checks in place to ensure the safety and quality of medicines administration was maintained, such as regular audits and staff competency checks.

People and their relatives said the staff wore the required personal protective equipment (PPE) when they were providing support. One person said, “They all wear PPE at all times. It always looks fresh and clean.” Staff had received training on infection prevention and control practice, including specific training and guidance relating to COVID-19 and the use of PPE. Staff were knowledgeable good infection prevention and control practice and their competency using PPE was observed and checked regularly.

People and their relatives told us they felt safe with staff. Comments included, “I feel safe when they are here, they do all the jobs that I can’t do. They sort everything out for me” and “I know [Relative] is safe in their hands and I feel safe”. Staff had received safeguarding training and understood their role in recognising and reporting safeguarding concerns. There were systems in place at the service to appropriately manage safeguarding concerns.

There was an enthusiastic, positive and caring culture amongst staff at the service. Staff had good knowledge about the people they supported and told us they enjoyed working at the service. One person supported by the service said, “They [the staff] are providing a good service, they are the same people on a regular basis. They always ask before they do anything. They know the routine and how you like it done.”

People and their relatives were able to give feedback about their care in a variety of ways. Examples included ongoing satisfaction surveys and during spot checks monitoring staff performance. The provider supported staff wellbeing and recognised their contribution in various ways. For example, they ran a scheme called ‘Thank you Fridays’ which involved senior managers making telephone calls to staff each Friday to thank them for their contribution and any specific good practice that week.

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 25 February 2020).

Why we inspected

We received concerns in relation to late and missed calls, the management of medicines and staff infection prevention and control practice. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from the concerns raised. Please see the safe section of this full report.

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.

Connected Health Plus is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The service supports older people and those with needs relating to dementia. Not everyone using Connected Health Plus receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 41 people were receiving personal care.

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

The service was delivered safely in accordance with regulation. Risk was effectively assessed, managed and reviewed to help keep people safe. People were supported to take their medicines as required. Staff were safely recruited although a small number of older records needed updating. Staff understood their responsibilities to report concerns.

People’s needs were assessed before the service started. Assessments were subject to regular review to ensure people’s needs were still being met. The service worked well with external professionals to ensure people’s health needs were met. Staff were supported through appropriate training and regular supervision. People were supported to eat and drink in accordance with their needs and preferences. Staff understood their responsibilities in relation to the Mental Capacity Act and delivered care accordingly.

People using the service and their relatives spoke positively about the way staff conducted themselves and the relationships that had formed. People were supported to express themselves and comment on the provision of care. The service helped people to retain their independence wherever possible and treated people with respect. People’s needs in relation to their faith and culture were considered as part of the assessment and care planning process.

Care plans were personalised and contained important details about people’s lives, histories and preferences. They were subject to regular review to with the involvement of the person and family members as appropriate. People’s needs in relation to communication and accessible information were met in accordance with the relevant standards. Complaints were addressed quickly, and written feedback was provided.

The registered manager completed regular safety and quality audits to ensure the service was meeting people’s needs. There was an open and positive culture present which promoted learning. Minor issues identified during the inspection were addressed in a timely manner. The service had achieved good outcomes for people through effective partnership working with families and professionals.

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 18 March 2019 and this is the first inspection.

Why we inspected

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

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.