Background to this inspection
Updated
7 September 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by an inspector and an Expert by Experience. 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 houses and flats.
This service is required to have a registered manager. The service did not have a manager registered with the Care Quality Commission. The management team were new and had been in post for 6 weeks at the time of our inspection.
The provider’s nominated individual confirmed an application was being submitted by a member of the management team to become the registered manager and this was subject to the relevant checks being completed. The nominated individual is responsible for supervising the management of the service on behalf of the provider. This meant they were legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the nominated individual or management team would be in the office to support the inspection.
Inspection activity started on 6 July 2023 when we visited the office. Telephone calls were made offsite to people who used the service and relatives on 17 July 2023 by the Expert by Experience. We also spoke with staff and professionals involved with the service. We had a face to face meeting via Teams with the management team on 31 July 2023 when we gave inspection feedback.
What we did before the inspection
We reviewed our systems and information we held about the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We took this into account when we inspected the service and made judgements in this report.
During the inspection
We spoke with 6 people who used the service and 7 relatives about their experience of Kare Plus Ipswich. We spoke with the nominated individual, a care manager, a deputy manager, the admin and care coordinator and 4 care staff.
We spoke with a representative from the local authority commissioning team and received electronic feedback from 5 members of staff, 1 relative and 1 professional involved with the service.
We reviewed a range of records which included care plans, risk assessments, medication records for 4 people and 3 staff records. We also viewed some of the provider’s policies and procedures, training data, quality assurance records, management monitoring and oversight records.
Updated
7 September 2023
Kare Plus Ipswich is a domiciliary care service providing care and support to people in their own homes. CQC only inspects where people receive a regulated activity of personal care. This is help with tasks related to personal hygiene and eating.
Where they do receive personal care, we also consider any wider social care provided. At the time of inspection there were 27 people who used the service and received personal care.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
The provider was not always able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. We signposted the provider to relevant information. We have made a recommendation the provider fully assesses the care and support provision at Kare Plus Ipswich to embed the principles of right support, right care, right culture into care planning and delivery.
In the 6 prior weeks to the start of our inspection a new management team had taken over the day to day running of the service. Improvements had been made and were ongoing regarding care planning and risk management and a new electronic care planning system was being implemented. Further work was needed to embed the new governance and oversight arrangements as at the time of the inspection it was too soon to assess their overall effectiveness.
This was a focused inspection to follow up on the previous breach of regulations and to check improvements had been made to mitigate the risk. We found that progress had been made and was ongoing regarding safe care and treatment and the service was no longer in breach of this regulation. However, the service remained in breach of regulation 17, as progress to their governance and oversight arrangements since our last inspection was slower than expected. The provider advised this was due to some personnel changes that had impacted on the delivery timescales.
Right Support:
People were supported by a staff team who were safely recruited and received training relevant to their role and to meet people’s needs. This included The Oliver McGowan Mandatory Training on Learning Disability and Autism. This is the government’s preferred and recommended standardised training for health and social care to undertake.
People received their medication as prescribed and staff adhered to infection prevention and control procedures in line with legislative requirements and recognised best practice guidelines.
Right Care:
Improvements had been made and were ongoing to the provider’s systems to assess and manage risks safely for people. People were supported to have maximum choice and control of their lives and for staff to support them in the least restrictive way possible and in their best interests; the polices and systems in the service to support this practice were being reviewed.
The majority of feedback from people and their relatives about their experience with Kare Plus Ipswich was positive and they were satisfied with their care and support arrangements. Where personal care was provided people said this met their needs, they were treated with respect, consent was sought and they were complimentary about the approach of staff.
On occasion where people had an issue the provider had acted appropriately to address this. We did signpost the provider to a quality care concern during the inspection.
Right Culture:
The provider's governance arrangements did not provide assurance the service was consistently well led. The systems and processes to oversee the quality assurance of the service were not robust and effective, as they had not identified the shortfalls we found during our inspection and regulatory requirements were not always being met.
Systems for auditing had been introduced but needed further development to consistently analyse, report and evidence the actions taken and where applicable lessons learnt. We signposted the provider to seek support in this area and were encouraged by them contacting support from relevant professionals including the local authority.
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 13 April 2022). We found breaches of the regulations. At this inspection we found some improvement had been made, the level of risk had reduced, but the provider remained in breach of the regulation regarding good governance.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.
Enforcement and Recommendations
We have identified a continued breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
We have made a recommendation that the provider research current guidance and best practice in supporting people who have a learning disability and autistic people.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect. 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.