Background to this inspection
Updated
4 March 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 team consisted of 1 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.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 24 January 2023 and ended on 2 February 2023. We visited the location’s office on 24 January 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with 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 used all this information to plan our inspection.
During the inspection
We spoke with the registered manager during the site visit. We spoke with 1 person who received support from the service and 8 relatives by telephone following the site visit. We also spoke with 6 care staff. We looked at 7 people’s care records and reviewed 5 people’s medicine records. We also viewed 3 staff files, call log records and documentation related to the governance of the service. The provider sent us further documentation we had requested during and following the site visit including recruitment records and some medicine records and processes.
Updated
4 March 2023
About the service
Zion Care Services Limited is a domiciliary care agency providing personal care to people living in their own houses and flats. At the time of our inspection, the service was supporting 44 people with personal care.
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
People told us their care calls were not always on time. People were not always supported by staff who had the language skills to communicate effectively with them which caused frustrations for people and relatives. Assessment records did not always contain appropriate language to describe people’s backgrounds.
Staff did not always support people in a way that reduced the risk of infection to them. People told us staff did not always have the skills to do basic household tasks. Assessments were not always detailed and did not always contain sufficient information to guide staff on how to meet people’s diverse needs. People were not always provided food and drink in line with their preferences. Staff did not always respect people’s home environment. People’s end of life wishes had not been discussed with them. Systems in place were not always effective in checking the quality of the service. Whilst improvements had been made to the service, systems failed to fully address concerns regarding late calls and a language barrier between staff and people they supported.
Risk assessments were in place to guide staff on how to mitigate risk to people. Medicines were administered safely. Staff understood the types of abuse and knew how to raise concerns. Accidents and incidents were recorded and analysed so patterns could be identified and action taken.
Staff completed an induction prior to supporting people and had access to significant training opportunities. The registered manager had implemented regular supervision and undertook competency checks. People were supported to access health professionals when needed.
People were supported by staff who were kind and caring. Staff respected people’s privacy.
Care plans were personalised and provided staff with guidance regarding how to meet people’s needs. Complaints were investigated, patterns were analysed and action was taken to address them.
The registered manager was approachable. People and relatives were given the opportunity to feedback regarding the service. The culture of the service had improved and staff and the registered manager were clearer about their roles and responsibilities. The provider had implemented a number of actions and improvements had been made at the service since the last inspection.
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 did not always support this practice.
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 20 January 2023). The service remains rated requires improvement. The service has been rated requires improvement for the last two consecutive inspections. 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 but the provider remained in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Zion Care Services Limited on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to person centred care and governance 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 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.