Caring for You

Caring for You is a domiciliary care agency which provides care to people in their own homes. Not everyone who uses this 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. At the time of our inspection 10 people were receiving the regulated activity of personal care.

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

Staff had appropriate knowledge of safeguarding people from abuse. However, systems and processes were not robustly in place to show how people would be protected from financial abuse and how staff are protected against allegations. There was some conflicting information as to whether staff handled people's money, such as for shopping. People did not receive a scale of charges or a contract to show how much they paid for their care. We made a recommendation for the provider to improve transparency in communicating costs to people, and for risk assessments to be in place where people need staff support with making purchases.

People said they felt very safe being supported by care staff. Relatives were happy staff supported their loved ones safely.

Care plans were in the process of being improved using new person-centred documentation. Information was clearer than at the last inspection, regarding people’s health and how to support them safely. This was work in progress at the time of the inspection.

People felt they received safe support with their medicines and there were more regular checks/audits of medicine records. However recording of medicines needed to be improved and the medicines policy needed to be more detailed.

Recruitment procedures were more robust to ensure staff’s suitability to work with vulnerable people. Staff training had improved as had the induction process, competency checks and staff supervision. All staff spoken with felt very well supported in their role to be able to provide care safely.

Daily notes were detailed and person-centred, but closer monitoring was still needed with regard to reviewing daily notes. These were stated as being audited monthly, yet the records we reviewed showed no management oversight of these since the end of December 2021. The provider said this was addressed immediately after our visit. Some gaps in care records suggested care had not been provided at times identified; the provider explained this was in part down to poor internet connection and they were working to improve this.

Policies and procedures were still being updated and we made a recommendation the provider seeks further advice for developing these so they become meaningful documents and support how the service is run.

Roles and responsibilities were more clearly defined and consultant staff had been employed to help drive improvements in the service. Staff understood the lines of accountability and knew who to refer to with any queries or concerns. People and relatives were confident in how the service was run and they were complimentary about the quality of the care they received. Questionnaires were due to be sent to people by the end of March 2022 and the provider agreed to share the results of these with CQC.

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 16 August 2021). 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 had taken steps to address the breaches of regulations. There was still a breach of regulation 17 (good governance) because although the provider had made some improvements, records were still in the process of being improved to demonstrate the safe management of people’s care.

This service has been in Special Measures since 16 August 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

We previously carried out an unannounced focused inspection of this service on 4 June 2021, breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve: Safe Care and Treatment; Safeguarding service users from abuse and improper treatment; Good governance; Staffing; Fit and proper persons employed; Requirements where the service provider is an individual or partnership.

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 and Well-led which contain those requirements.

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 changed from inadequate to requores 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 Caring for You on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 a continued breach at this inspection in relation to record keeping to show how well the service is run.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Caring for You is a domiciliary care agency which provides care to people in their own homes. Not everyone who uses this 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. At the time of our inspection we were not able to determine how many people were receiving personal care. This was because we were given conflicting information and the registered provider was unable to confirm.

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

Risks to people were not adequately assessed, mitigated or monitored to ensure the safe delivery of care. Recruitment procedures were not followed and staff were employed without any evidence of interview or suitability checks carried out.

Since the last inspection, some staff had undertaken training in the form of e-learning, but this was insufficient to ensure all staff had the necessary skills to support people with their specific needs. There was no evidence of any competency checks carried out to ensure staff were able to safely provide care.

People and relatives were mostly positive about the way the care staff supported them in their homes.

The registered provider had not taken sufficient action to address the issues and breaches of regulations raised at the last inspection. Policies and procedures were not up to date or reflective of practice. The registered provider lacked oversight of the service delivery and there were no robust systems and processes to assure the quality of the care provided.

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 and there were breaches of regulations in relation to people’s safe care, staffing, recruitment and good governance, including record keeping. The registered provider completed an action plan to show what they would do to improve. At this inspection we found limited evidence of improvements and there were continued breaches in the regulations.

Why we inspected

This focused inspection was prompted in part due to concerns received about safeguarding people from the risk of financial abuse. A decision was made for us to inspect and examine those risks, as well as to check the registered provider 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 and Well-led which contain those requirements.

We have found evidence that the provider needs to make improvements. Please see further information in this full report.

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

The overall rating for the service has changed from requires improvement to inadequate. 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 Caring for You 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 continued breaches in relation to people’s safe care, staffing, recruitment and good governance, including record keeping 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.

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 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.

Caring for You is a domiciliary care agency which provides care to people in their own homes. Not everyone who uses the 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. At the time of our inspection there were nineteen people receiving personal care.

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

The registered provider did not have effective systems of governance in place to maintain and improve the quality and safety of the service. We identified two recent safeguarding notifications which we were not notified about.

Safe systems of recruitment were not always followed to ensure staff were safe to work with vulnerable people.

Staff were not always supported with an induction, supervision and role specific training, to ensure they had the knowledge and skills to support people. Staff had not had their competence to administer medicines assessed.

People told us they felt safe and staff we spoke with had a good understanding of how to safeguard adults from abuse. One person said, “My carers are marvellous and I feel absolutely safe with them.”

We have made a recommendation about the registered provider following best practice guidance when managing people’s finances to ensure people are protected from the risk of financial abuse.

Staff knew what to do in the event of an emergency. Risk assessments contained basic information to help minimise risk.

People we spoke with told us staff were usually on time and they had not experienced any missed care visits.

Most staff told us they felt supported and they would be happy for a relative of theirs to be supported by the service.

People told us they liked the staff and the managers, who went out of their way to provide them with person centred care.

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 21/08/2018)

Why we inspected

The inspection was prompted in part due to concerns received about staff recruitment, training , management of the service and safeguarding people from the risk of financial abuse. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this 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.

The registered provider told us they would take action to improve the areas of concern.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caring for You 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 monitor the service.

We have identified breaches in relation to safe medicines, staff recruitment, training and supervision, accurate records and the management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 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.

At our last inspection we rated the service good. One key question was rated ‘Requires Improvement.’ The service had not always been safe in relation to management of medicines. At this inspection we found the provider had made improvements in this area and was no longer in breach.

There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We saw evidence of a robust medicine management in place and staff were trained and competent in this area to ensure all policy and procedures were followed.

People and their relatives told us they were happy using the agency and felt the staff had the right training to be able to support them with their care needs.

Individual risks to people's safety were known by staff. Accident and incidents were reported and robust in looking at any lessons learnt.

Staff had regular opportunities to update their skills and professional development. Staff demonstrated an understanding of the Mental Capacity Act (MCA) 2005.

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 motivated and worked well as a team, with effective support from one another and from the management team. Staff had supervisions and an annual appraisal as well as team meetings.

Care records contained clear information covering all aspects of people’s care and support and staff had a caring approach to working with the people who used the service.

There was a clear management structure so that all staff knew their roles and responsibilities. There was an open and transparent culture in which staff felt valued and able to approach the registered manager.

Further information is in the detailed findings below.

Caring for You provides domiciliary care services to people in their own homes. The people who receive these services have a wide range of needs. At the time of the inspection, the service provided care and support to 22 people.

The service had a registered manager in post, who was also the registered provider, at the time of 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 told us they felt safe and staff had received safeguarding training in order to keep people safe. There were enough staff to meet people’s needs with a regular, consistent staff team and there were robust recruitment practices in place, which meant staff had been recruited safely. Risks to people and staff had been assessed.

The recording of the administration of people’s medicines was not safe. Records did not provide a clear and accurate record of the medicines people were prescribed and the medicines which staff had administered. This demonstrated a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People felt staff had the necessary skills and training to provide effective care. Staff told us they felt supported and we saw staff had received induction and training. Staff received ongoing supervision, although the frequency was not in line with the registered provider’s own policy.

We saw from the care files we reviewed the registered manager sought and obtained consent from people, prior to their care and support being provided.

People and their relatives we spoke with told us staff were caring. The staff we spoke with were enthusiastic and were driven to provide good quality care. Staff told us how they respected people’s privacy and dignity and the people we spoke with confirmed this.

Some care plans were personalised and others required further development in order to be personalised and person centred. Care plans were reviewed regularly. People were offered choices in relation to their care and support. Appropriate referrals to other health care professionals and services for additional care and support for people were made when necessary.

Regular quality assurance audits took place. People told us they felt listened to and that the service was well led. The registered manager encouraged a culture of openness.

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

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We looked at a sample of two care records and saw each person had a care plan and risk assessment which covered their needs. We saw regular reviews of the care plans had taken place.

We spoke with four people who told us they felt 'safe' with the care staff. All four people and the two relatives we spoke with provided positive feedback about the staff and service.

We saw the provider had safeguarding and whistleblowing policies in place to provide staff with guidance about protecting people from abuse. The two members of staff we spoke with were aware of the different types of abuse and described how they would respond if abuse was suspected or happening.

However, we found that one incident regarding a service user being given an incorrect dose of medicines had not been reported to the Care Quality Commission (CQC) as required by regulation 18 of the CQC (Registration) Regulations 2009. The manager told us they had reported this matter to the local authority safeguarding team and believed it was an oversight that the CQC had not been notified. The manager sent the notification immediately following the inspection.

Is the service effective?

We spoke with four people who used the service. All the people we spoke to were happy with the service provided and told us the staff understood their care and support needs. Comments included:

'They never let me down.'

'They are friendly. I'm quite satisfied.'

'I tell them what I want and they do it.'

'They're wonderful.'

We spoke with two relatives who were complimentary about the service. One relative said: 'It's a very flexible service. My [relative] loves the carers.' Another relative told us: 'The service is totally flexible. The carers are lovely.'

Is the service caring?

All the staff we spoke with told us there were enough staff to meet people's needs and that they had enough time to support people in the way they wished. People told us they were able to do things at their own pace and were not rushed.

Is the service responsive?

Staff said they were aware of the complaints policy and explained to us what they would do if a complaint was made. The four people and two relatives we spoke with told us they knew how to make a complaint but they had never had any cause to complain. We found people were made aware of the complaints system.

Is the service well-led?

We spoke with the manager regarding the audits used to assess and monitor the quality of service people received. Audits were carried out on areas such as: staff training, staff supervisions, spot checks and care records. We saw documentary evidence which confirmed this. This information was fed into action plans where areas for improvement were identified.

Staff meetings were held at least three times a year in order to ensure staff views and opinions were taken into account in relation to the running of the service. We saw meeting minutes which confirmed this.

We looked at a sample of feedback questionnaires which had been completed by people who used the service. The sample we looked at was positive.