In House Care

Updated 14 December 2022

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

This inspection was carried out by two inspectors 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. However, they were in the process of deregistering and not available on the day of inspection. A new manager was in place who planned to register.

Notice of inspection

We gave the service 48 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 13 September 2022 and ended on 11 October 2022. We visited the location’s office on 13 September 2022.

What we did before the inspection

We reviewed information we had received about the service and sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with 3 people who used the service and 6 relatives of people using the service, about their experience of the care provided. We spoke with 10 members of staff including the branch manager, a director, a team leader, the compliance manager, 5 care workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 4 people’s care records and multiple medication records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 14 December 2022

About the service

In House Care is a domiciliary care service providing personal care to people living in their own homes. The service provides support to older and younger adults, people with dementia, people with a learning disabilities and autistic people, people with eating disorders, mental health conditions or sensory impairment. At the time of our inspection there were 29 people using the 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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: People were not always supported to have maximum control of their care, care staff were sometimes late and people were not always informed, this impacted on people and their families. People’s choice in care delivery and independence through the care provided in their own homes was respected. Information was accessible, such as 'Easy read' guidance and information for people if required.

Right Care: Care was not always person-centred, however people’s dignity, privacy and human rights were considered and planned into care. Staff had not received training in supporting people with a learning disability but had completed an autism awareness course.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives. People and their relatives were not always informed in changes to when their care would be delivered.

Risk assessments and associated care plans did not always contain consistent information to support staff to mitigate risk. There was not always enough staff to meet people’s needs, and medicines were not always managed safely. People were protected from the risk of abuse by staff who had been recruited safely. People were protected from the risk of infection as staff had access to personal protective equipment [PPE] and understood the latest guidance. Incidents and accidents were recorded and monitored for trends and patterns.

Staff did not always have the training skills and experience to meet people’s needs. Records for transition into other health care services needed some improvement but staff had worked in partnership with other health care professionals to meet people’s health care needs. People were well supported with fluid, hydration and specialist feeding regimes.

Systems and processes had not consistently identified errors and concerns, where they had, corrections had not been made prior to the inspection. People were not always informed about changes in their planned care and did not always feel listened to. The provider was planning improvements to care records to provide clearer guidance for staff and had recruited new staff to the office to support recruitment and training. People spoke positively of the branch manager who was due to register with the Care Quality Commission and felt improvements had started to be made.

People did not always feel well supported due to staff skills and experience, but they had developed friendly relationships with staff who were kind and caring. Religion and culture were recorded in care records but there was a lack of guidance for staff on how to support people. People were involved in writing and reviewing their care plans and their privacy dignity and independence was respected and supported.

Care planning needed some improvement to ensure people received person centred-care that fully met their needs. People had a mixed experience of how the provider and management team managed their concerns but there was evidence that formal complaints were responded to in line with the providers policy and procedure. Staff were trained in end of life care and end of life wishes were recorded.

People’s needs were assessed before they joined the service and people who lacked capacity were supported by staff with a good understanding in this area. 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

This service was registered with us on 11 March 2022 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the full report.

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

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 safety of the service, staff training, skills and knowledge and the managerial oversight 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.