County Healthcare Services Limited

County Healthcare Services Limited is a domiciliary care agency registered to provide personal care to people living with dementia, learning disabilities or autism, mental health, older people, younger adults and sensory impairment. One person was receiving personal care at the time of the inspection.

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

Whilst people’s regular medicines had been given safely further improvement was needed around the records of medicines given on an ‘as required’ basis. The person was supported by staff who understood how to recognise and escalate safeguarding concerns should they have any.

Improvements had been made to the recruitment systems in place. Whilst we noted some improvement to care records people did not always have care records in place that reflected their needs.

Whilst some improvements had been made to systems that monitored safety in the service following our last inspection, we found they had not always been effective at identifying concerns. Further improvements were needed to ensure a robust, planned monitoring system was put in place to enable the provider to have oversight of the quality of people’s care.

People were happy with the care they received and felt safe. Improvements had been made in seeking feedback from people who received support from the service. Staff felt supported by the registered manager.

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 inadequate (Published 14/05/2021) and there were multiple breaches of regulation. We placed conditions on the providers registration for the requirement to send CQC monthly reports on key areas.

At this inspection enough improvement had been made to ensure staff were safely recruited and the provider was no longer in breach of this regulation. However enough improvement had not been made to the systems that ensure people receive safe care or in the monitoring of the service and the provider remains in breach of these regulations (Regulation 12, safe care and treatment and Regulation 17, good governance).

This service has been in Special Measures since 14 May 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

This was a planned inspection based on the previous rating.

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.

This inspection has identified a continued breach relating to the governance and oversight at the service and ensuring people received safe care and treatment. We will continue to monitor the improvement within the service through existing conditions we have placed on the providers registration. This includes sending us monthly reports of action the provider has taken to make improvements within the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

County Healthcare Services Ltd is a is a domiciliary care agency providing personal care to people in their own homes. The service was supporting two people from the location, with personal care in their own homes at the time of our inspection.

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

Some records were not available when requested at the time of the inspection of the office visit. This was due to documents such as care plans and risk assessments not being in place for people using the service.

There was a lack of provider oversight which meant risks to people’s safety had not been identified and responded to appropriately. Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm. The systems in place had failed to identify the areas for improvement found at this inspection including the care planning, risk assessments, safe recruitment processes and safe administration of medication.

Care plans were not in place for known health conditions to enable staff to have the information they needed to mitigate risk and meet or respond to their needs.

People and relatives we spoke to said they felt safe however, one health professional told us they had some concerns about staff members approach when supporting people to transfer safely.

Staff we spoke to told us they had received some training to meet people’s needs.

Medication administration records (MAR) did not always include the current list of medications prescribed for people using the service. This meant care staff did not have accurate records to refer to, ensuring they were giving the correct medication at the correct time.

Audits need to be improved to provide clear and robust information and evidence of outcomes for people.

Systems and process which were in place were not robust to protect people from potential harm.

Staff we spoke to told us they understood their roles and responsibilities, had received some training and felt supported by the management.

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)

This service was registered with us on 03 September 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the lack of pre-assessments, care plans, risk assessments, medication management, poor communication and concerns with the safe and correct use of equipment. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service.

The overall rating for the service following the first inspection is Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report to see what actions we have asked the provider to take.

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 17 Good governance due to the lack of provider oversight, systems and process’ in place to assess, monitor and improve the quality and safety of the services provided. Regulation 12 Safe care because people were exposed to the risk of harm as their care needs and risk associated with their care were not identified and recorded. and treatment and Regulation 19 Fit and proper persons employed due to failing to follow safe recruitment processes at this inspection.

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.