Genuine Carers - Kirklees

Genuine Carers – Kirklees is a domiciliary care agency which provides personal care to people in their own homes. At the time of our inspection, 32 people were receiving a service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people and providers must have regard to it.

Right Support

Staff had been trained and were assessed as competent to administer medication. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice, although records required improvement.

Right Care

Risks assessments were not always consistently recorded to ensure safe practice. The management team and staff understood people’s care needs. Staff understood how to protect people from poor care and abuse.

Right Culture

Feedback we received was positive around the care people received.

At this inspection we saw minor improvements in the service people received. Feedback from people and relatives was more positive, although people still reported experiencing missed calls. The management team did not have sufficient oversight of this. Office staff over-relied on people reporting late or missed calls and were not proactive in responding to electronic call monitoring, which identified when care tasks did not appear to have taken place.

Quality systems remained ineffective as systems of audit were not routinely carried out. There was little evidence of oversight of the service in key areas.

People and relatives were consistently asked for their feedback through telephone calls, spot checks and satisfaction surveys. However, concerning responses in relation to a recent satisfaction survey had not been acted on.

People said they received suitable support with their medication needs. Improvements were needed to records to demonstrate the safe management of medicines. Risks to people were fully understood by the management team and staff were reasonably confident. However, this information was not always included in risk assessments we looked at.

People and relatives said they were mostly satisfied with their call times and staff stayed for the full duration of the call. They provided positive feedback about the caring nature of staff who they said understood their care needs.

Some improvements had been made since our last inspection. Suitable travel time had been allocated between calls, consent was being recorded and mental capacity assessments had been put in place.

Formal staff support was not detailed in records we looked at, although staff said they were given plenty of time to cover what they needed and felt well supported.

People largely felt safe with this service. Records relating to safeguarding investigations showed these events had been looked at. Healthcare partners were clearly involved in people’s care as referrals were made because staff identified concerns and the management team acted on these needs. People said staff were good at identifying when they were unwell and acted on this.

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 6 June 2022) and there were breaches of regulation. 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 some improvements had been made, although the provider remained in breach of regulation.

Why we inspected

We carried out an announced inspection of this service on 16 March 2022. 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 the reliability and punctuality of visits to people's homes, the safe management of medicines, recording consent and mental capacity, plus systems to ensure oversight and quality of care provided.

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, Effective 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 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 Genuine Carers – Kirklees on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach of regulation in relation to the management and oversight of the service.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, we are keeping the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over 2 consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Genuine Carers – Kirklees is a domiciliary care agency which provides personal care to people in their own homes. At the time of our inspection, 31 people were receiving a service.

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 and relatives experience of the care provided significantly varied. Some people and relatives were enthusiastic about the service, whilst others had poor experiences. Some people and relatives said they had experienced missed calls. We received mixed feedback about the timeliness of calls and records did not show call times were reliable. The provider did not have adequate oversight of the service people received.

Recruitment records were not sufficiently robust.

Systems to assess, monitor and review the quality of the service were not adequate. The provider did not have systems in place to check people received a suitable service. Insufficient action had been taken to ensure confidentiality was maintained. Spot checks of care packages were increased following our inspection.

Staff understood their safeguarding responsibilities, although recording of safeguarding incidents was not robust.

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; however, the systems in the service did not support this practice. There was an absence of mental capacity assessments and consent to care records as these had not been carried out. These records were created following our inspection.

We were not assured the management of medicines was safe. Some of the feedback we received indicated medicines had not been administered on some occasions. Medication records were not being robustly reviewed. Staff were trained in administering medicines and had their competency checked.

Risks to people were routinely being assessed and staff were aware of risks to people. With one exception, people and relatives consistently told us staff always wore their PPE.

With one exception, which the provider addressed, we found people received support to access healthcare services when they needed this. Staff assisted people in the preparation of meals and received training in food hygiene. Staff received formal support through meetings, supervision and appraisals.

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 2 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about missed calls, the culture within the service and maintaining confidentiality. A decision was made for us to inspect and examine those risks.

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

The provider has taken action since the inspection which they expect will improve the service quality. However, we need to see these systems are effective and sustained over an extended period.

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 good to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Genuine Carers – Kirklees 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 breaches in relation to the reliability and punctuality of visits to people’s homes, the safe management of medicines, recording consent and mental capacity, plus systems to ensure oversight and quality of care provided.

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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 six 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.

People’s experience of using this service:

•People told us they felt safe. Risk assessments were in place to reduce the risk of harm to people. Care workers completed medicines training and an assessment of their competency to administer medicines was completed. Suggested improvements to the management of peoples creams were implemented immediately.

•Staff recruitment was safe. People told us care workers did not miss their calls and were usually on time. New staff received induction and there was a programme of ongoing staff supervision, spot checks and refresher training.

•Staff were caring and kind. Peoples right to privacy was respected and staff took steps to maintain their dignity.

•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. Where people lacked capacity, support was provided in their best interest's although records did not clearly evidence this.

•One of the care records we reviewed was person centred and detailed but improvements were needed to another persons care record to ensure they were sufficiently detailed.

•People and their relatives were aware of how to raise a complaint should the need arise. The management team asked people and their relatives for feedback at regular intervals. Staff meetings were held but care workers comments had not been routinely recorded within the minutes. One care worker told us they did not feel supported by the management team and we saw noted one care worker had not had a rest day for three months.

•There were systems in place to monitor the quality of the service although these had not identified areas where further improvements could be made.

Rating at last inspection:

At the last inspection the service was rated good (published 15 October 2016).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We previously inspected the service on 08 November 2013 and at that time we found the registered provider was meeting the regulations we inspected.

Genuine Carers is a specialist homecare agency who provides home care predominantly to people of south Asian origin in the Kirklees area of West Yorkshire and in Oxfordshire.

The registered provider is also the registered manager for the service. 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.

Relatives we spoke with told us they were very happy with the service provided and they felt their relation was safe with Genuine carers. Staff had received safeguarding training and were aware of their responsibility to report any concerns to their manager.

Care plans contained risk assessments which were relevant to people’s individual needs and the environment, although one of these lacked detail for staff about how risks could be reduced when supporting people to transfer.

The registered person had a robust system in place to vet potential employees. All staff were trained and assessed as competent to administer people’s medicines.

Staff told us they felt supported. New employees were supported in their role and there was a programme of on-going refresher training for existing staff. Staff received regular supervision to ensure they had the skills and competence to meet people’s needs.

Staff had received training in the Mental Capacity Act and understood people’s rights to make decisions about their lives.

Staff were caring and kind. People’s privacy and dignity was respected and care plans reflected the need to encourage people to retain their level of independence. The service catered for people's diverse cultural and language needs.

People had care plans in place which noted the tasks they required support with, as well as detail about their choices and preferences. Staff told us these were reflective of people’s needs and we saw these were updated regularly.

Relatives of people who used the service and staff told us the service was well-led and relatives were very happy with the care provided.

The registered person had a system in place to monitor the performance of the service. Staff were monitored at regular intervals and audits were completed of people’s daily records. The registered provider asked people and staff for feedback, this information had been reviewed and fed back to staff.

Relatives of people who used the service were positive, comments included:

'We get the same staff, they are reliable and caring.'

'I have been more than impressed.'

Peoples' diversity, values and human rights were respected.

We looked at care records for three people who used the service. We saw that each record included details of their medical history, personal preferences, likes and dislikes.

Three members of staff we spoke with were able to describe a number of types of abuse.

We looked at three sets of staff records and found that effective recruitment and selection processes were in place.

Documentation also showed an effective system for auditing the quality of service.

We saw from the staff files that care staff including volunteers were supported and had received appropriate training for their role.