Background to this inspection
Updated
8 April 2022
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team: Two inspectors and an expert by experience carried out this inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and Service Type:
This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people.
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:
This inspection site visit took place on 03 and 04 February 2022 and was announced. We gave the service 24-hours’ notice of the inspection visit, because we wanted to be sure the office staff would be available for the inspection.
What we did: Before the inspection: We reviewed information; we had received about the service. We sought feedback from the local authority who work with the service. The provider was not asked to complete a Provider Information Return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they make. We took this into account when we inspected the service and made the judgments in the report.
During the inspection:
The registered manager was not available on the days of the inspection. We spoke with four people and one relative to ask their views about the service. We spoke with three members of care staff, the care manager and the care coordinator. We reviewed records, including the care records of seven people using the service, recruitment files and training records for seven staff members. We also looked at records related to the management of the service such quality audits, accident and incident records, and policies and procedures.
After the Inspection:
We continued to seek clarification from the provider to validate evidence found.
Updated
8 April 2022
About the service:
Care focal is a domiciliary care agency which provides 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 the inspection 27 people were receiving personal care.
People’s experience of using this service:
Risks were not always identified or updated, and risk management plans were not in place to manage these risks. People's medicines were not always safely managed. People who had a ‘Do Not Attempt Resuscitation’ form (DNAR) in place, did not have information in their care plans about where in their home this could be located. The provider's recruitment process was not robust, and staff were not always recruited in line with the recruitment policy. Assessments were carried out prior to people joining the service but they did not always ensure that people’s needs could be met and were not used to develop care plans. People and/or their relatives were not involved in planning their care and support and care plans were not always updated. People’s capacity to consent to their care and support was not documented. People who had a lasting power of attorney did not have these details recorded in their care plans. The provider’s quality assurance systems were not effective. Feedback was sought from people about the service, but the provider did not always act upon shortfalls identified.
People told us they felt safe. There were appropriate adult safeguarding procedures in place to protect people from the risk of abuse. People were protected from the risk of infection. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were supported through training and supervisions. Staff supported people to eat and drink enough to meet their needs. The provider did work within the principles of Mental Capacity Act (MCA). People had access to healthcare professionals when required to maintain good health. The provider worked in partnership with other healthcare agencies.
Rating at last inspection:
This service was registered with us on 08/04/2020 and this was their first inspection.
Why we inspected:
The inspection was prompted in part due to concerns received about neglect, late visits, lack of risk assessments and poor medicine management. A decision was made for us to inspect and examine those risks.
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 monitor the service and will take further action if needed
We have identified breaches in relation to safe care and treatment, person-centred care, fit and proper persons employed, and good governance.
Please see the action we have told the provider to take at the end of this report.
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.