Care at Home Group Warrington Also known as Care At Home Group

Care at Home Group Warrington is a domiciliary care service that provides personal care to people in the community. The service provides support to older people, people who misuse drugs and/or alcohol, people with physical disabilities, sensory impairments, dementia, and younger adults. At the time of our inspection there were 92 people using the service.

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. All people using the service at the time of inspection received personal care.

People’s experience of using this service and what we found

People were supported with effective and responsive care in a well-led service. There were some people who were not always happy with the times of their care, however they were happy with the care workers supporting them.

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.

People using the service were supported with access to other health professionals to ensure any emerging health needs were responded to quickly.

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 21 May 2021). That inspection was to follow up breaches of regulations in relation to staffing, good governance, and safe care and treatment. At that inspection we found the provider was no longer in breach of those regulations. There was also a breach of Regulation 11 (Need for consent) which was not inspected at that time from the inspection of 16 December 2020. At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 11.

Why we inspected

At our last inspection the rating for the service remained requires improvement. We carried out this inspection to check if the service had improved. This report only covers our findings in relation to the key questions of effective, responsive, 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 requires improvement to good. 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 Care at Home Group Warrington on our website at www.cqc.org.uk.

Follow up

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

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and phone calls to engage with people using the service, relatives, and staff as part of this performance review and assessment.

Care at Home Group Warrington provides care and support to people in their own homes across the Warrington area. 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 the inspection there were 42 people using the service.

At our previous inspection in December 2020 the provider was in breach of regulations. At this inspection we found enough improvements had been made and the provider was no longer in breach of regulations. However, evidence that could be reviewed was limited as these improvements had been implemented following a change in management after the last inspection. The focus now needs to be on further embedding and sustaining improvements over a longer period of time in order to achieve an overall rating of good.

People's experience of using the service and what we found

People and their family members told us they had seen improvements in the overall quality of the service and would now recommend Care at Home to others.

People's health, safety and wellbeing were assessed and managed safely. Care plans provided necessary information and guidance for staff identify and respond to incidents or events associated with specific risks; such as diabetes and epilepsy. People felt safe with the staff who supported them and family members were reassured their loved ones were well looked after.

Staff now had the right skills, knowledge and experience to carry out their role and keep people safe. The manager had completed a full review of staff training and induction and ensured all staff had received mandatory training and additional training specific to people's needs. Staff spoke positively about the quality of training they now received.

Staff told us better organisation of their rotas and call runs and increased staff numbers meant they were able to ensure people received their calls at the right times. Managers monitored call times throughout the day and took immediate action where issues were raised. People and family members told us their calls were now completed on time by consistent staff.

Robust measures were now in place to prevent the spread of infection, particularly in response to COVID-19. Staff followed correct guidance in the use and disposal of PPE and told us they received appropriate training and guidance. Staff were supported to access regular COVID-19 testing and vaccinations.

The recruitment of a new management team had resulted in improvements identified at this inspection. Staff, people and family members spoke positively about well the service was run and improvements made.

Systems and processes for assessing, monitoring and improving the quality and safety of the service had now been implemented and were used effectively. Regular checks and audits were completed and areas of improvement identified and action taken.

Managers fully engaged with staff, people and family members to obtain their views about the service and ways to improve. Staff now felt well-supported and listened to and told the manager regularly acknowledged their hard work and achievements.

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 (report published 16 December 2020) and there were multiple breaches of regulation found.

Why we inspected

Following the last inspection, the provider completed an action plan to tell us what they would do and by when to improve the service. We undertook this focused inspection to check they had followed their action plan and confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 Care at Home Group Warrington on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Care at Home Group Warrington provides care and support to people in their own homes across the Warrington area. 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 the inspection there were 71 people using the service.

People's experience of using the service and what we found

People’s health, safety and wellbeing were sometimes put at risk due to a number of concerns identified during this inspection. Risk management was not always consistent, and people and family members did not always feel assured about their safety.

Staff did not always have the right skills, knowledge or experience to carry out their role safely and effectively. Concerns with staff numbers and the poor organisation of their rotas placed staff under additional pressure. This often resulted in people receiving their calls late and not for the agreed amount of time. Lateness of staff sometimes resulted in people’s prescribed medicines not being administered at the right times.

There were not enough assurances that the service consistently met current national guidance and standards in relation to infection prevention and control (IPC). Staff had limited knowledge about some IPC procedures, including the removal and disposal of personal protective equipment (PPE). The provider did not always make sure that adequate measures were in place to prevent the spread of infection; particularly in relation to COVID-19.

Whilst people’s needs had been assessed and plans were in place, staff did not always have access to relevant, up-to-date information. Staff told us they often did not have time to read people's care plans and that care plans were not always available in people's own homes.

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, systems in place did not always support this practice. For example, the outcome of mental capacity assessments completed by the provider did not always accurately reflect the answers given.

Mixed feedback was received from people and family regarding the management of the service. Some described it as ‘disorganised’ and ‘poor communication and record keeping’. Staff told us they felt the service was disorganised due to lack of consistent management and limited office staff support.

There were widespread, significant shortfalls in the way the service was led which had resulted in multiple breaches of regulation. Governance systems were not robust enough to identify issues and drive improvement. Staff told us they did not feel involved, appreciated or engaged with.

Rating at last inspection and update - The last rating for this service was requires improvement (published 26 June 2019) and there were multiple breaches of regulation.

Why we inspected

We carried out an announced comprehensive inspection of this service on 30 May and 6 June 2019. 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 safe car and treatment, staffing and governance.

The inspection was also prompted in part due to concerns received about staffing, lack of staff training and infection control. A decision was made for us to inspect and examine those risks.

We undertook this focused inspection to check the provider had followed their action plan, to inspect and examine areas of concerns received 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. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

The provider took some actions following the inspection to mitigate some risk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12 (Safe care and treatment), Regulation 11 (Need for consent), Regulation 18 (Staffing) and Regulation 17 (Good governance) at this inspection.

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

Follow up

Following the inspection, the provider submitted an action plan telling us 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 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 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 of 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.

Nightingales UK Limited provides care and support to people in their own homes. The provider has renamed the service ‘Care at Home’ but it remains registered in the original name. They work with people who are elderly, disabled or have additional needs to help them remain independent at home. Not everyone using Nightingales UK Limited receives regulated activity; The Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection there were 151 people using the service.

People’s experience of using this service and what we found:

Staff supported people to take their medicines safely and people told us they felt safe with the staff providing this support. However, we found some inconsistencies in the record keeping of records for medications, so it was difficult to identify accurate administration of prescribed treatments.

Staff noted improvements to the service since the provider had taken over the service. They felt supported and listened to by the new management team and the provider. However, we found that some staff had not received support and training necessary for their role. The provider had actions in place to update staff with training and to provide all staff with regular supervision and appraisals which had recently commenced.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. However, some staff had not received training in the principles of the Mental Capacity Act, 2005; and care files lacked enough information to show these principles of support had been taken into consideration.

Care records had been recently updated and captured personalised and important information regarding people’s histories, families and preferences. However, we found various issues with the lack of updates regarding people's records which created risks in managing accurate care planning.

Staff were knowledgeable of local safeguarding procedures. The service had learnt from recent safeguarding incidents however improvements were still needed in the recording and auditing of safeguarding incidents to show a transparent process and clearer audit trail in managing incidents.

Governance systems had not always identified areas needing improvement. The provider had taken recent actions to improve the management of the service and employed specialist staff to help them develop improved quality assurance systems of the service.

People who used the service and their relatives spoke positively about their experience and the care provided by staff. Staff treated people with kindness and respect and supported their dignity in a sensitive manner. We received mixed comments from relatives regarding consistency of staffing levels. We received two complaints from people during the inspection which we referred to the provider to review.

Staff knew people well. They understood their needs and the manager had recently tried to reorganise rotas and increase recruitment of staff to help provide better consistency in providing the same staff to people receiving support.

More information is provided in the full report.

Rating at last inspection: Good (report published April 2017)

Why we inspected: This was a scheduled inspection based on the previous rating from the last comprehensive inspection. We had received information of concern prior to the inspection from two safeguarding incidents that had been reviewed by Warrington local authority.

Enforcement: We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Follow up: You can see what action we told the provider to take at the back of the full version of the report. We will continue to monitor intelligence we receive about the service until we return to visit as per our re inspection programme. If any concerning information is received, we may inspect sooner.

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

The head office is in the Padgate area of Warrington and is accessed via the ground floor.

Nightingales provides care and support to people in their own homes. They work with people who are elderly, disabled or have additional needs to help them remain independent at home. At the time of the inspection there were 129 people using the service. .

The service had a registered manager. 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. The registered manager is also the owner and director of the company.

People were treated with dignity and respect. Staff understood people's preferences, likes and dislikes regarding their care and support needs. However care plans were inconsistent. Whilst they all held basic details of the persons needs some were detailed and included people’s preferences and choices, whilst others would benefit from more person centred information.

Staff recruitment processes were robust, however information on staff files was sometimes difficult to find. They would benefit from a more structured format to include a referencing index.

People told us they were safe. Medicines were managed safely. Risk assessments identified the risks to people and how these could be minimised. Sufficient numbers of staff were available to meet people's needs.

People were involved in decisions about their care and how their needs would be met. Managers and staff had received training on the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005.

Staff had access to on-going training. They were knowledgeable about their roles and responsibilities.

Staff knew how to respond to people's needs in a way that promoted their individual preferences and choices regarding their care. Where necessary people’s nutritional needs were well met and they had access to a range of professionals in the community for advice, treatment and support.

Care was planned and delivered in ways that enhanced people's safety and welfare. However home visits were not always provided in a timely manner.

People were supported to maintain good health and had access to healthcare services. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people's needs.

People had access to the complaints procedure and told us that they knew how to make a complaint should they need to. We found that the management team had regular contact with people and dealt with any issues and concerns as they arose.

The service regularly requested feedback from people who use the service. People, relatives and staff said the management were approachable and supportive.

Systems were in place to monitor the quality of the service. People felt confident to express any concerns and these were addressed by the registered manager.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with the manager and other staff and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Most people received their medicines when they needed them and in a safe way. Arrangements for some people however, were unclear and this placed them at unnecessary risk of harm. Medicines were administered appropriately by trained care workers and, where necessary were kept safely in people's homes.

Is the service effective?

We found that care plans for managing medicines were in place and care workers had clear information to follow to ensure that people were supported to take their medicines safely. Medication records were incomplete and it was not always possible to see exactly what medicines had been administered.

Is the service well led?

We saw that audits, or checks of medicines, were carried out regularly to assess the way medicines were managed and to ensure that people continued to receive the support they needed.

People said staff gave them the attention they required.

Staff spoken with demonstrated their understanding of peoples needs and of how to provide needs led care and support to the people who used the service.

Care records showed that people's individual needs and preferences had been taken into account and that people had been given a choice in how they wished to be cared for.

Care records showed that a person's independence was actively supported. Staff were knowledgeable about a person's care and gave examples of how they treated people with respect and dignity and promoted people's independence.

Mediation was generally well managed. However medication records were not always clear. The records did not evidence that people were receiving the correct levels of medication.

Comments received included "Staff have never let me down';' Staff are generally on time and when they are late they let us know" 'The staff are kind and considerate and treat people with respect."

People told us that 'Staff are friendly and make me feel at ease', 'The staff treat me well and I am totally comfortable with them', "Staff certainly know what they are doing."

People told us that they were encouraged to speak their mind about the staff and services provided. One person said that they had been given a questionnaire to complete about the service. Another person told us that staff carried out reviews of care and people were asked their opinions of the care provided.