We carried out a review of the data available to us about Raystra Healthcare on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Raystra Healthcare, you can give feedback on this service.
Raystra Healthcare Limited is a domiciliary care agency and supported living service providing personal care to people in their own homes. 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. At the time of our inspection there were 37 people using the service.
People’s experience of using this service
Although various aspects of the service, including people’s care delivery, staff practices, staff training and complaints were monitored, these processes had not identified the shortfalls identified during this inspection. These shortfalls had not impacted on the service people received and had not put people at risk. The provider however, needed to review how they completed their monitoring of the service, to ensure their system was effective in identifying shortfalls and responsive enough to address areas for improvement.
We have made a recommendation in relation to quality monitoring.
We found two people’s care plans and risk assessments did not reflect their current needs. When discussed with the registered managers, they took immediate action to address these. They also started to make other alterations to, for example, the staff training record, so it captured information which would support improved monitoring of the service. Time was needed for the provider to implement a more formalised quality monitoring system.
People and the relatives we spoke with, told us they were happy with the care provided by the agency staff. There were arrangements in place to assess people’s needs and identify and support associated risks. A relative confirmed this process had taken place when their relative had been referred to the agency for support, and we saw reference to this when inspecting people’s care records.
Guidance was given to staff on how to manage people’s risks and on what care activities needed to be provided during a care visit. Care staff confirmed this when we spoke with them.
Care visits were allocated to staff through the adopted electronic system and monitored by senior staff to ensure they were completed along with the required care activities.
Where people’s needs were complex or where needs had altered, staff worked hard to liaise with external health and social care professionals to get appropriate assessments completed so care could continue safely. In two people’s cases, staff had struggled to get appropriate assessments completed. However, staff had continued to provide people with the care they required, and the support needed to lower risks to the people’s health and wellbeing.
Apart from the shortfall in two people’s care plans and risk assessments (identified during the inspection) care plans and risk assessments were generally available to staff for guidance. All information about people’s care and support needs was provided through the service’s electronic system which staff could access when they were mobile.
Registered managers were fully up to date on the support people required, including any changing needs, as they liaised with senior staff and monitored staffs’ care entries on the electronic system. This ensured the registered managers could support staff with any changes in people’s care and risk management and, where needed review with commissioners, the need for any necessary changes to people’s care visits.
The provider’s recruitment process included appropriate checks which were completed before staff worked with people. The results of these checks helped the registered managers make safer employment decisions.
Staff were provided with training when they first worked for the agency and thereafter to support safe working practice. Spot checks took place to monitor the quality of care and support provided to people. Staff knew how to report any concerns they had related to poor practice. When poor practice or behaviours which did not meet with the provider’s values were identified, the registered managers took action to address these.
The provider had safeguarding processes in place which staff received training on; staff told us they knew how to raise safeguarding concerns. The registered managers ensured they adhered to local authorities safeguarding protocols; sharing relevant information with appropriate agencies as required. There were checks in place to ensure potential risks, such as self-neglect through refusal of personal care, were also identified and reduced.
People’s needs, in relation to their medicines, were assessed and where support was required with medicines, this was provided by staff who had received relevant training.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
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 3 February 2022).
Why we inspected
The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the initial assessment of people’s care needs, when a referral is made to the agency for emergency care support and, how information is made available to care staff prior to them providing that support. This inspection examined those areas of risk.
We found no evidence during this inspection that people were at risk of harm from the themes associated with this concern. Please see the safe and well-led sections of this full report.
This was a focused inspection only looking at the key questions, safe and well-led. 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 remains based on the findings of this inspection. However, We have found evidence that the provider needs to make improvements. Please see the well-led sections of this full report.
The provider started to take immediate action to make the improvements required at the time of the inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Raystra Healthcare Limited on our website at www.cqc.org.uk.
Recommendation:
We have made a recommendation in relation to quality monitoring.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Raystra Healthcare provides domiciliary care services to people who require care and support in their own homes. The service operates to provide short-term personal care as part of a reablement service to enable people to leave hospital, return home and regain independence. At the time of the inspection a service was being provided to 39 people.
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
Improvements had been made to how the registered manager monitored the quality of the service.
The registered manager was aware of which incidents must be reported to CQC when these occurred and these were being reported accordingly.
Improvements had been made to staff recruitment checks.
People were protected from harm and abuse through the knowledge of staff and management. Risks to people's safety were identified, assessed and appropriate action was taken to keep people safe. Staff followed appropriate infection control procedures to protect people during the pandemic. People's medicines were safely managed. People and their relatives told us they felt assured that care visits would take place.
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 Requires improvement (published 16 March 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.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
Raystra Healthcare provides domiciliary care services to people who require care and support in their own homes. The service operates to provide short-term personal care as part of a reablement service to enable people to leave hospital, return home and regain independence. At the time of the inspection a service was being provided to 26 people.
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
We found all required staff recruitment checks had not been completed on staff, before they delivered people's care. This put people at risk of receiving care from those who may not be suitable to work with vulnerable people.
Notifications of incidents relating to people using the service had not been submitted to CQC to ensure we were able to check if the correct actions had been taken.
The provider's monitoring systems had also not identified that their recruitment policy had not been fully implemented and required notifications had not been submitted to CQC.
People were protected from harm and abuse through the knowledge of staff and management. Risks to people's safety were identified, assessed and appropriate action was taken to keep people safe. Staff followed infection control procedures to protect people. People's medicines were safely managed. People and their relatives told us they felt assured that care visits would take place and staff would contact them in the event of any late calls.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were treated with respect and kindness and their privacy and dignity was upheld. There were arrangements in place for people and their representatives to raise concerns about the service.
We have made a recommendation about staff recruitment procedures.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
The inspection was prompted in part due to concerns received from a local authority about the delivery of personal care. A decision was made for us to inspect and examine those risks.
This service was registered with us on 13 August 2019 and this is the first inspection.
We have found evidence that the provider needs to make improvements. 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.
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.