Zion Care Services Limited Also known as Zion Healthcare

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.

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 71 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 were not always supported safely. People’s medicine administration records (MAR) were not always accurate and medicines weren’t always administered safely. People were supported by staff who told us they had not received safeguarding training and did not always understand how to keep people safe. Risk assessments were in place but were not consistently followed by staff.

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.

People were not always supported by staff who were fully trained to meet their needs. Relatives told us staff did not understand people’s dementia needs. People’s assessments were not always holistic and did not consider people’s diverse needs. Staff did not always ensure people received food and drink in line with their dietary needs and preferences. Staff did not always contact health professionals when needed.

Staff did not always spend meaningful time with people due to them being rushed. Staff sometimes conversed with each other in a language that people did not understand which relatives found disrespectful. People’s records did not always use dignified language.

People’s care plans did not always provide consistent and clear guidance for staff to meet people’s needs. Staff did not always communicate with people in a way that maximised their understanding. A complaints policy was in place, but complaints were not always dealt with in line with the policy.

Systems in place to check the quality of the service were not always effective. For example, they failed to identify medicine recording errors or the lack of mental capacity assessments in place. The registered manager and staff were not always aware of their roles and responsibilities. People were asked for their views about the service, but sufficient action wasn’t always taken to improve the service.

Staff wore Personal Protective Equipment (PPE) in line with current guidance. Staff had worked alongside health professionals to ensure they were adequately trained to meet a person’s complex clinical needs. People and relatives told us staff were lovely and caring. Relatives told us the registered manager was supportive and approachable. The provider had engaged positively with commissioners to improve the service.

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 14 April 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to a range of concerns received regarding medicines, risk management, mental capacity and safeguarding. 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, Caring, Responsive 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.

Following the inspection, the provider took immediate action to reduce risk to people they supported. The provider voluntarily agreed to not take on any further care packages until their systems were adequately improved and records had been fully transferred from a paper to electronic system. The provider also confirmed they had allocated a senior for every area they provide care for so there was more oversight.

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 and will take further action if needed.

We have identified breaches in relation to person centred care, consent, safe care and treatment, staffing and governance at the service at this inspection.

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