Background to this inspection
Updated
26 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 team consisted of an inspector and an 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 48 hours' notice of visiting the office location. We gave notice of the office visit, because it is a small service and we needed to be sure that the registered manager would be available to support the inspection.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We considered any information we had received since the last inspection. We sought feedback from partner agencies. We used all of this information to plan our inspection.
During the inspection
We spoke with one person who used the service about their experience of the care provided. We also spoke with three members of staff and the registered manager.
We looked at the care records of one person. We reviewed other records in relation to the management of the service. These included four staff recruitment files, training records, quality monitoring audits, and the provider’s policies and procedures.
After the inspection
We continued to seek clarification from the provider to validate evidence found. The provider also sent us their current action plan.
Updated
26 August 2021
About the service
4Life Healthcare Limited is a domiciliary care agency providing personal care to people in their own homes. At the time of the inspection one person was receiving support with personal care.
People’s experience of using this service and what we found
The care plan and risk assessments we viewed did not provide enough guidance for staff to keep the person safe from harm. Staff had not had training on the person’s specific health needs, or how to provide end of life care if a person’s health deteriorated. These are ongoing concerns from our last inspection. The provider has now put in place competency assessments and spot checks to assess staff practice.
We found staff had not been safely recruited to ensure they were of good character. Poor quality recruitment processes had continued since our last inspection.
The person using the service felt safe. We had not received any allegations of abuse since the last inspection. There had been one complaint, and the person felt this has been dealt with appropriately. Due to a lack of incidents since the last inspection, we were unable to review if the provider’s response to incidents had improved.
At the last inspection medicines were not managed safely. At this inspection, staff did not support anyone to take their medicine. Staff did support moving the medicine from the prescribed container into another box. They had no guidance in place to ensure this was done safely and in accordance with current best practice standards and guidelines.
Staff had access to personal protective equipment to reduce the risk of COVID-19 transmission. Staff engaged regularly with the COVID-19 testing. Two staff who provided the majority of the care for the person had not had COVID-19 training.
We identified that one external professional referral had been needed. This had not been completed until prompted by the inspection team. This left the person at risk of unsafe care.
The service was not providing enough support with eating, drinking and social support for us to make judgements in these areas. The service did not support anyone who needed support to make decisions. We were therefore unable to assess the provider’s effectiveness of following the Mental Capacity Act. This is legislation for people who may not be able to make decisions for themselves.
The person that used the service spoke positively about the care provided, and kindness of staff..
At the last inspection we had concerns about care planning, risk assessments, staff training and the safety of recruitment at the service. We found these areas still needed further improvement. The provider did have an action plan to improve these areas; however, since our last inspection limited action has been taken.
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 inspection was rated Inadequate (Published 14 January 2021)
Why we inspected
The last inspection was rated inadequate, and with breaches of regulation. This was a routine inspection to assess if required improvements had been made.
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 ongoing breaches in relation to Regulation 12 (Safe Care and Treatment), Regulation 17 (Governance) and Regulation 19 (Fit and proper persons) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we have asked the provider to take at the end of this full report. We have sent the provider a warning notice. A warning notice gives a timescale to make the required improvements.
Follow up
We will review future information we receive about this service. We will return to visit as per our re-inspection programme and to review compliance with the warning notice. If we receive any concerning information we may inspect sooner.
Special Measures:
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.