Archived: Care at Home Group Cheshire East

Cheshire East Care at Home Group provides care and support to people in their own homes across the Cheshire area. 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 there were 29 people receiving personal care.

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

Overall people were satisfied with the support they received. Some people told us there had been an improvement to the consistency of care calls, whilst others felt this could be improved further.

The provider had made improvements in relation to the areas of concern we found at our last inspection, including medicines management, staff training, safeguarding and regulatory requirements. However, further improvements were required in relation to records relating to medication and The Mental Capacity Act (MCA) records. Quality monitoring processes needed to be fully embedded.

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. However, there remained some gaps in staff knowledge.

We have made a further recommendation about following MCA guidance.

There was ongoing work to ensure people received a consistent staff team. The provider had introduced a new electronic care management system (app) to monitor care visits, which provided more reliability than the previous one in place.

Following the last inspection, the provider had arranged safeguarding training for all staff. Records were more robust, demonstrating that safeguarding concerns had been reported appropriately through relevant procedures.

The provider had reviewed systems to ensure safer recruitment procedures were being followed.

Improvements had been made to the administration of medicines, however we found some recording issues and further staff training was being planned.

Infection control training had been provided to staff and changes to government guidance were considered and implemented. Staff had access to appropriate PPE.

Improvements had been made since the last inspection in relation to staff training, supervision and support.

The governance systems in place were more robust. There had been a management restructure and several new roles had been recruited to. However, whilst there had been improvements in the provider’s governance systems, these needed to be developed further and fully implemented.

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 12 January 2021). There were multiple breaches of regulation, including safe care and treatment, safeguarding service users, ensuring fit and proper person are employed, staffing and good governance. 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.

This service has been in Special Measures since 7 January 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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cheshire East Care at Home Group on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cheshire East Care at Home Group provides care and support to people in their own homes across the Cheshire area. 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 there were 38 people receiving personal care.

People's experience of using the service

Staff did not always have access to relevant information and guidance in order to safely manage risks to people, placing them at potential risk of harm. Several people did not have risk assessments or care plans in place, to provide staff with guidance about their care needs.

Recruitment procedures were not effective as some staff had started working prior to suitable checks being carried out. We were not assured all staff had the relevant skills, knowledge and experience to carry out their role safely and effectively. Staff inductions were not robust enough. Staff had not been provided with regular supervisions or spot checks to check their competencies.

Appropriate procedures had not always been followed to ensure any safeguarding concerns were reported as per local procedures. Staff had not always followed procedures to ensure medicines were administered safely.

Audits had not been carried out on a regular basis to ensure effective oversight and monitoring of the service. Robust systems were not in place to ensure learning occurred when things went wrong. There were widespread, significant shortfalls in the way the service was led which had resulted in multiple breaches of regulation.

Staffing levels were sufficient, people told us familiar carers usually visited at the expected time. The provider was recruiting new staff and agency staff had been used in some cases. Staff told us that rotas could be better organised, which was being reviewed.

Staff were aware of infection control practices in relation to the latest COVID-19 government guidance for the use of Personal Protective Equipment (PPE) to keep people and staff safe.

Whilst staff generally sought consent from people, they were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The systems in the service did not always support this practice. We have made a recommendation about the Mental Capacity Act within the report.

Overall people were satisfied with the care and support they received. People told us that staff treated them well and were kind in their approach. However, they were not always fully engaged to express their views of the care.

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 30/03/2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about overall care quality and recruitment concerns.

We have found evidence that the provider needs to make improvements. The provider took some actions following the inspection to mitigate risks.

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 five breaches of regulation in relation to safe care and treatment, staffing, safeguarding, fit and proper persons and good governance.

You can see what action we have asked the provider to take at the end of this full 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.

Follow up

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.

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 time frame. 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.