Archived: JK Caring for You

JK Caring for You is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of our inspection 18 people were using the service.

Not everyone who uses this type of service receives 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

The provider continued to put people at risk due to poor management of medicines.

The provider had not improved on all concerns we found at previous inspection. The provider had failed to make enough improvement to their quality assurance systems and poor practice had not been identified. This continued to put people at risk of harm. Following our inspection, because of the provider’s poor financial stability, the local authority had removed the people they funded care for from the service. The provider had also moved offices without the prior approval from us.

The provider had recently reduced the size of the service which had improved the timeliness of people’s care calls. However, we continued to find people with consistently late calls which had not been spotted by managers.

Improvement had been made to how concerns about people’s safety were managed. However, the provider had not recognised some staff practices were unsafe.

Some improvements had been made to people’s care plans which were now more focused on the person. However, further improvement was needed to ensure people’s equality, diversity and human rights were fully represented in care plans.

Staff received the training they needed to support people but did not always put this learning into practice. People were supported to have enough to eat and drink, access healthcare where needed and other health and social care services.

People sometimes felt rushed by staff but thought they were kind and caring. Not everyone felt involved in their care with regards to call times. Staff promoted people’s independence and respected their privacy.

Improvement had been made to how the provider managed complaints and concerns from people and their relatives.

People had opportunities to give their opinions about the care they received and felt there had been recent overall improvement in the service.

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.

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 14 August 2019), and there were multiple breaches of regulation and the service continued to be in special measures. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Following our last inspection we imposed a condition on the provider's registration so they could not accept any new care packages, including any increases to current care packages being provided, without our approval.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

All outstanding enforcement against this provider is now concluded. All representations and appeals have been concluded.

Please see the action we have taken at the end of this report.

People’s experience of using this service:

Sufficient improvement had not been made since our previous inspection and this is the second consecutive inspection where the service is rated as inadequate.

The provider’s audits and monitoring systems continued to fail to ensure people received good quality care.

The provider had not ensured people’s medicines were managed safely. Information about people’s medicine and the support they needed was not completed or available to staff.

People had risk assessments in place. However, these did not always identify how people’s specific health conditions and care needs affected their safety.

The registered persons had failed to consistently follow safeguarding procedures when some people made allegations of abuse. The registered persons had also failed to notify us of safeguarding concerns within the service. Therefore, people who used the service were at risk of not being protected from abuse.

People continued to receive late care calls, which put their safety and wellbeing at risk.

The assessment of people's care needs had not always taken into account how their health conditions affected their daily lives.

People were at risk of not receiving the support they needed with eating and drinking, as they continued to receive late care calls.

Not everyone felt respected or listened to by the registered persons, office staff, managers and care staff.

People’s preferences were not always respected because the provider did not have enough care staff to meet these preferences.

Staff worked with and made referrals to health professionals when people needed support or their needs had changed.

Since our previous inspection, the provider had a new procedure to resolve issues before they became a complaint. This had been welcomed by those who had received it.

Rating at last inspection: Inadequate (report published 17 January 2019).

The overall rating for this service continues to be ‘Inadequate’ and the service remains in ‘special measures’.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Why we inspected: This was an unannounced, inspection to check whether the provider had made the require improvements since our previous inspection.

Enforcement: 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: We will continue to monitor intelligence we receive about the service until we return to visit, as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We had previously carried out an announced comprehensive inspection of this service on 29 January and 22 February 2018. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the safe management of people’s medicines and governance practices.

This focused inspection, 15 November 2018, was prompted by a high volume of concerns and complaints shared with us by people using the service, their relatives and the local authority. These complaints were in relation to the safety and governance of the service. We also checked the provider had followed their action plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to the key questions of safe and well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for JK Caring for You on our website at www.cqc.org.uk.

During this focused inspection four breaches of legal requirements were found. These breaches were in relation to the safe care and treatment of people, protecting people from abuse, staffing and governance. We found serious shortfalls in the management of risk, insufficient staffing levels and leadership and governance. The overall rating for this service has deteriorated from 'Requires Improvement' to 'Inadequate' and the service is therefore placed in 'special measures'. The overall rating for this service is Inadequate which means it will be in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

JK Caring for You is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It is registered to provide a service to older people, younger adults, people with dementia, learning disabilities or autistic spectrum disorder, people with mental health conditions, a physical disability and sensory impairment. At the time of our inspection 61 people were using the service.

Not everyone who uses JK Caring for You may receive a 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.

JK Caring is required to have a registered manager in post. They were present for our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People did not always receive their medicines as prescribed. Where visits had been missed or were late, people had not received their medicines, which put them at risk of harm. Records relating to people’s medicine were not always clear, accurate, complete or up to date. Staff did not always record when they had administered people’s medicines. This placed people at serious risk of not receiving their medicines as prescribed.

People were placed at serious risk because the provider had not ensured people always received safe care and support. People did not always receive their planned care calls and staff were frequently late to people’s homes.

The provider had not ensured sufficient plans had been put in place when considering how to reduce the potential risk of pressure sores. Information about one person’s capacity to make their own decisions was contradictory, meaning they may not be involved in decisions about risk. This could impact on people’s freedom, choice and control.

The provider had not ensured one person was protected against the risk of potential or on-going abuse as staff had not followed local safeguarding procedures.

The provider had not ensured there were sufficient staff to meet people’s needs safely. People experienced late and missed calls and were not told when staff would be late. This placed people at serious risk of avoidable harm because their care needs were not always safely met.

We found there was a lack of management oversight and the systems and processes in place had not ensured that people received their care visits or medicines as planned and this had placed some people at risk of avoidable harm. The provider’s action plan from our previous inspection, although instigated, had been ineffective in mitigating risks and breaches.

People and staff were not always given the information they needed and there was a lack of communication.

Complaints from people, relatives and external healthcare professionals had been responded to but had not been used to drive improvement within the service. The provider received a high volume of complaints about missed and late calls and people not having their calls returned. This information had not been used to drive the required improvement to the service.

You can see what action we told the provider to take at the back of the full version of the 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.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people, younger adults, people with dementia, learning disabilities or autistic spectrum disorder, people with mental health conditions, a physical disability and sensory impairment. At the time of our inspection 79 people were using the service.

Not everyone using JK Caring for You may receive a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; for example, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The provider of JK Caring for You is registered as an ‘Individual’. Individuals register in their own name with the Care Quality Commission. They are not required to have a registered manager in place because they are directly responsible for carrying on and managing the regulated activity of ‘personal care’. As the ‘registered person’ they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we had rated the service provided as Good. Following this inspection we have changed this rating to Requires Improvement.

People’s medicines were not managed safely. There was a lack of clear guidance for staff to follow with regards to what medicines people were prescribed and the support they needed. Records were not always completed fully or accurately.

Although the provider had systems in place to monitor the provision of the service, these had not ensured the quality and safety of care provided was consistently meeting people's needs.

People were not supported to receive timely care and staff were often late for people’s care calls, which impacted on them and their families. People were not always informed when care staff were running late for their care calls and did not know who would be arriving.

Staff had received training in infection control practices but people gave mixed feedback on staff’s hygiene and cleanliness when they supported them.

When people raised complaints these were addressed and resolved. However, people did not feel the service was always responsive in addressing any verbal concerns they raised.

Although people had care plans in place there was sometimes a lack of focus on people’s own preferences and wishes in relation to how they would like their care delivered. However, where staff had built relationships with people they had got to know their preferences and wishes which helped them to provide person centred care.

People felt communication could be improved from managers and office staff when care staff were going to be late for their care calls. People had difficulty getting through to the office and did not always have their telephone calls returned. They did not always find staff at the office helpful when they telephoned them.

The provider took action when safety or safeguarding incidents happened. Where necessary the provider worked with the person, their relatives and outside agencies in investigating incidents and ensuring the person was kept safe. Where poor staff practice was identified, disciplinary action was taken. The provider understood their responsibilities under the duty of candour.

The provider had systems in place to help safeguard people from abuse. Staff had received training in and understood how to protect people and keep them safe from avoidable harm and abuse. Risks associated with people’s care had been assessed and plans were in place to help minimise these risks.

People’s care needs were assessed and staff that provided people’s care had received training to meet their needs. People were complimentary about the skills of their “regular” carers but did not feel all staff had the skills to meet their needs.

People’s consent was sought by staff before they helped them with any care or support. The provider worked with other health and social care professionals as required to help them to deliver effective care and support to people.

People were able to build positive relationships with the care staff they saw often. The provider aimed to keep care staff within their own localities to help people receive a consistency of care. People were treated with kindness, respect and dignity by the care staff that supported them.

We found two breaches of the regulations relating to safe care and treatment and good governance. You can see what action we have told the provider to take at the back of the full report.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

The staff we spoke with had a good understanding of safeguarding procedures. One staff member explained, "I would have no hesitation in reporting any concerns to my manager or CQC.' We saw in the training records that the managers and the support staff all received regular training in safeguarding. This meant that the staff had up to date information on safeguarding procedures.

From our observations and the information we saw in care plans, policies, procedures and audits the provider's safety monitoring systems were robust. The staff showed that they had a clear understanding of their role in providing care and in safeguarding the people they supported.

People's care plans and the staff rotas showed that the management had taken people's care needs into account when making decisions about the number of staff required. Management had considered the skills and experience staff would need. This showed that the provider had taken steps to ensure the staffing provision was safe and met the needs of each person.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

Documents we reviewed showed support plans and risk assessments were individualised and regularly updated. Support planning matched people's assessed needs. This meant people were protected against ineffective care provision because people's needs were adequately assessed.

There was evidence that people were involved in the assessments of their needs and care plan reviews. We saw in care plans and found from talking with people who used the service that the care provided was being constantly adapted to meet people's needs.

Is the service caring?

We spoke with people who used the service to gain an understanding of their experiences of the support they received. Their responses were all positive. One person told us, "I can't fault them; they look after me very well." Another person said, 'They are wonderful, they never let me down. They are all light hearted and have time to talk to me.'

Staff we spoke with described being respectful to and working with people to understand their needs. One staff member told us, "I love my job and working with the people I support.' The staff we spoke with said that they felt it was important to have time to interact with each person while they were doing their job. They demonstrated that they were aware of potential risks, people's rights and their responsibilities. This showed people were safeguarded against inappropriate care provision because staff understood people's individual needs.

The registered manager told us the importance the provider put upon ensuring that people's dignity was maintained at all times. They told us that this was part of the induction training given to new staff.

We saw copies of the service customer satisfaction surveys. All had positive comments. One person wrote, 'We are delighted with the service, it has made a big difference to us.'

Is the service responsive?

We found that care plans were person centred and contained detailed information about the person and their choices and preferences. We saw that people's views had been obtained about the type of support each person needed. The customer survey feedback forms showed that staff performance and the care people received had prompted positive responses from the people who used the service.

We saw that the provider was regularly in contact with social care and health professionals that provided support to people. This meant that people's health and welfare was regularly reviewed and monitored.

The staff and people who used the service said that when they had any concerns, they could talk with the manager as they would always listen and address anything they raised.

We saw that the service responded appropriately to complaints received. This followed the service's policy. Responses to issues raised and actions undertaken were recorded. This meant the provider had minimised the risks of unsafe care because complaints had been acted upon

Is the service well-led?

The provider had systems in place to ensure the quality of the service was regularly monitored and reviewed. There were systems in place to provide feedback to staff about changes and developments. We saw evidence that actions had been taken where issues for improvement had been identified. This meant people were protected against inappropriate care because the provider had systems to check the quality of care.

We were shown evidence of complaints that had been handled correctly and in a timely-manner. This meant the service was well-led because people were enabled to make complaints, which managers acted upon.

The registered manager and the staff we spoke with were knowledgeable about the people who used service, changes to legislation and developments in care provision.

All the staff we spoke with said they understood their responsibilities around safeguarding people's welfare. They said that if they witnessed poor practice they would report their concerns.

We saw that incidents and accidents were reported and investigated. Where possible actions had been taken to prevent re-occurrence or to mitigate any risks.

We found that management and support staff received mandatory and specialist training. All the staff held or were working towards vocational qualifications relevant to their role. Staff told us that training was provided to assist in their professional development.

Staff told us that they had worked with the people who used the service for some time and really enjoyed their work. They told us that there was a good team spirit and everyone listened to any concerns raised and acted to resolve these. They said that they felt they were supported and involved in the development of the service.

Everyone we spoke with told us that they were satisfied with the care and support that they received. One person commented, 'They do a smashing job.' Another person said, "They are getting better all the time."

We found that the right people had been involved in making decisions about care and support. This made sure people had enough information to consent to the care and support they required. People told us that they were always asked their agreement in relation to how they received their care and support at the start of every care visit.

We saw service had improved their range of training and development opportunities for staff. This meant they were kept up-to-date with current practice.

We found that the provider was continuing to develop and improve their systems for assessing and monitoring the quality of service they provided. We saw they demonstrated how they learned from feedback to show the service was run for the benefit of the people using it.