Profad Care Agency Limited

Profad Care Agency Limited is a domiciliary care agency providing personal care to 25 people in their own houses and flats at the time of inspection.

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 had not ensured effective oversight of the service to ensure improvement in people’s care and risks to people were mitigated.

The provider's systems and processes had not always ensured effective oversight of the safety and quality of the service.

We could not be assured people received their medicine as prescribed. There was inconsistent information recorded about dosage of medication. Improvements were required to ensure staff were up to date with the provider's required training and their competency was assessed.

Safe recruitment practices were not always in place. The provider failed to follow their own procedures for the safe recruitment of staff.

We were unable to confirm staff members stayed with individuals for the allotted period of time. People told us staff left early on numerous occasions.

Systems and processes were in place to protect people from the risk of abuse. Staff had a good understanding of how to keep people safe and how and to report concerns. The provider and manager promoted a positive culture that supported choice and independence as much as possible. People’s social, cultural and religious needs were met.

The management team worked in partnership with other professionals to ensure good outcomes for people.

People, relatives and staff were invited to give feedback on care which was reviewed by the manager and monitored for themes. Staff received regular supervision and appraisal and felt well supported by the new manager.

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 21 July 2021). At this inspection we found the provider remained in breach of regulations and the service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

At our last inspection we recommended that staff files were reviewed, and risk assessments were implemented for any health conditions that may affect how staff can work. We recommended call times were reviewed and monitored to ensure people received care in a timely manner. At this inspection we found the provider had initially acted on the recommendations; however, they had failed to sustain the improvements.

At our last inspection we recommended complaints received were reviewed and responded to in line with the duty of candour. We saw this had taken place and the improvement had been sustained.

Why we inspected

We undertook this focused inspection to check whether the warning notice we previously served in relation to regulations 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

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 has remained 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 Profad Care Agency Limited on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified 2 continued breaches in relation to safety monitoring and managerial oversight of the safety and quality of the service at this inspection.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special measures

The overall rating for this service is requires improvement. The rating for well-led continues to be 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.

Profad Care Agency Limited is a domiciliary care agency providing personal care to 37 people in their own houses and flats at the time of inspection.

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 not been made since the last inspection and people remained at risk.

Risk assessments were not always in place to provide staff with the information required to support people safely. Risk assessments were not kept up to date or reviewed after incidents.

Care plans did not always contain up to date, detailed information on people’s care, based on their current needs.

Records showed gaps in recording to evidence that people’s medicines had been administered as prescribed. Records of care tasks had gaps in the recording of skin integrity checks, repositioning checks and when cream was applied.

Systems and processes were either not in place or robust enough to ensure there was effective oversight of the service. Audits were not completed regularly and had not identified the issues found on inspection.

The provider had breached people’s confidentiality on two separate occasions. This was being investigated externally.

Complaints had not been recorded or responded to appropriately. People did not always feel listened to.

Systems were in place to protect people from the risk of abuse however, there was no system in place to monitor accidents and incidents to identify possible trends or patterns.

People were protected from the spread of infection, including COVID-19.

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 24 October 2020) with a breach of Regulation 17, 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 not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to call times and staff knowledge. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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 risk assessments, oversight, confidentiality and medicines 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

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.

Profad Care Agency Limited is a domiciliary care agency providing personal care to 27 people at the time of the inspection.

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.

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

There was a lack of oversight and systems to monitor the service were not effective. Whilst it was evident that the provider had some quality control systems in place, we observed that they did not always identify issues, and were therefore not always effective. Where issues were identified robust action plans were not always created.

The service was not always safe. People’s risks were not always appropriately identified and assessed. Staff were not always provided with clear guidance to manage people’s risks. This placed people at risk of receiving care that may cause them harm.

Medicines were not always safely managed. The correct protocols were not always in place and there was no guidance to inform staff when to administer certain medicines.

People were not 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 policies and systems in the service did not support this practice.

Improvements were required to end of life care planning to meet best practice guidance such as that provided by the Gold Standards Framework.

People were safeguarded from abuse and neglect by a staff team who were trained in safeguarding procedures.

There was enough staffing to meet people’s needs. People told us the staff who provided their care were consistent and knew them well.

Infection prevention and control (IPC) was well managed and staff were trained in safe IPC practices whilst providing care. Appropriate Personal Protective Equipment (PPE) was made available to and worn by staff.

Staff were supported by a robust induction policy and had received relevant training to ensure that they had the required skills and experience to support people appropriately.

Staff and the management team were kind, caring and compassionate. People and their representatives told us that the staff were kind to them and respected their dignity and their privacy.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

People and their representatives told us they were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

The provider had systems in place to encourage and respond to any complaints or compliments. The provider and management team had good links with the local communities within which people lived.

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 10 June 2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and training. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections 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. 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 oversight and governance at this inspection.

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.