Background to this inspection
Updated
3 June 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.
This was a focused inspection to follow up on a concern we had about recruitment practices.
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 homes.
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 it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 22 March 2023 and ended on 3 May 2023. We visited the location’s office on 22 March and18 April 2023.
What we did before the inspection
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 gathered feedback from the local authority and reviewed the previous inspection report. We used all this information to plan our inspection.
During the inspection
During the inspection we looked at a variety of records, including 3 care files and 6 staff recruitment files. We also looked at records relating to the management of the service, including audits and staff training records. We talked to the registered manager and 2 care assistants. We spoke with1 person who used the service and 4 family members on the telephone.
Updated
3 June 2023
About the service
Complete Care 4 U Limited is a domiciliary care agency. It provides personal care to people living in their own homes. 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. At the time of our inspection the service was supporting 46 people with the regulated activity of personal care.
People’s experience of using this service and what we found
We found improvements were needed in some aspects of governance of the service. Staff recruitment processes were not always robust and there were shortfalls in medicines documentation and auditing. The registered manager took action following our inspection to address these issues.
The people we spoke with could not praise the agency highly enough. They told us carers were kind, caring and respectful. People said they valued their carers' reliability and professionalism.
People and their relatives told us they felt safe using the service. There were enough staff available to meet people's needs at their requested time and we received no complaints about staff being late or not staying for the correct length of time. Staff were up to date with their required training. Staff followed correct infection control practices when providing care and support.
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 supported 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
The last rating for this service was good (published 4 November 2022).
Why we inspected
We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about recruitment processes. A decision was made for us to inspect and examine those risks.
We inspected and found there was a concern with recruitment processes, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well led.
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 requires improvement based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Complete Care 4 U on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified a breach in relation to recruitment processes.
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.