Archived: 4Life Healthcare Limited

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.

About the service

4Life Healthcare Limited is a domiciliary care agency providing personal care to older people in their own homes. At the time of the inspection seven people were receiving support with personal care. An additional person passed away shortly before the inspection. We reviewed their care records too.

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

Systems and processes were not effective in preventing abuse. Policies were in place but not followed. Staff did not receive enough guidance or the required training to provide safe care, therefore, people were not always protected from potential abuse.

Safeguarding issues and risks were not recognised when they should have been. The registered manager had poor knowledge of people’s needs and therefore could not identify possible risks. We found some incidents had not been fully investigated or reported by the registered manager.

Staff did not receive all the training they required. One member of staff had not completed an induction into their role. Staff had limited knowledge of people’s complex health conditions. No competency checks were carried out to assess the quality of care given by staff.

The care plans and risk assessments did not provide staff with enough information to ensure people received consistent and safe care. End of life care plans were not in place despite the people using the service coming towards the end of their lives.

Medicines were not managed safely. There was a lack of guidance for staff supporting people with their medication and staff were not provided with information of people’s medical needs. Medicines were not recorded in a safe way and we were not assured that staff administering medication had received medicine training.

Infection control practices were unsafe during the COVID-19 pandemic. Systems were not effective in ensuring staff followed national COVID-19 guidance. This could potentially increase the risk of transmission of coronavirus.

Safe recruitment practices were not followed, as staff were deployed to work unsupervised without all necessary recruitment checks having been completed.

There has been a lack of learning from incidents occurring at the service. Effective actions have not been taken to prevent re-occurrence and concerns raised were not always resolved. The registered manager had little oversight into the day to day management of the service and there were no systems in place to identify areas for improvement or make essential changes to the service.

There was a continued lack of understanding, oversight and governance to ensure people received a safe service. Systems that were in place were not implemented effectively and audits did not identify ongoing concerns with the service.

People using the service had other healthcare professionals involved in their care. There was no evidence to demonstrate good quality multi-agency working or that professional advice was sought and followed.

There were no effective systems in place to identify and respond to complaints and concerns. We were told people had raised complaints about receiving late calls. We found complaints and concerns were not formally investigated and responded to and therefore were not assured concerns around timekeeping were responded to.

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 June 2019 and this was the first inspection.

Why we inspected

We received concerns in relation to care plans, recruitment, staff skills, medicines and infection control practice. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This is where we had the highest level of concerns about the service.

We have found evidence that the provider needs to make improvements. The provider had not taken effective action to mitigate the risks. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end 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 Regulation 12 (Safe Care and Treatment), Regulation 13 (Safeguarding service users from abuse and improper persons), Regulation 17 (Governance) and Regulation 19 (Fit and proper persons) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had failed to notify the Care Quality Commission (CQC) about incidents that occur at the service. This was in breach of regulation 18 of the (Registration) Regulations 2009.

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. These appeals have now ended. The CQC have added additional conditions onto the providers registration.

Follow up

We will review future information we receive about this service. We will return to visit as per our re-inspection programme. 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.