St Gregory's Homecare Ltd

Updated 7 March 2024

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

The inspection was carried out by 2 inspectors and a regulatory coordinator; 2 inspectors attended the location’s office and a regulatory coordinator made telephone calls to staff off-site. Telephone calls to people who were using the service and their relatives were made by 3 Experts 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 CQC 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

This inspection was unannounced.

Inspection activity started on 13 December 2023 and ended on 2 February 2024. We visited the location’s office on 13 and 20 December 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authorities who work with the provider. 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 used all this information to plan our inspection.

During the inspection

We spoke with 19 people who use the service and 8 relatives about their experiences of the care provided. We spoke with 14 staff including the nominated individual, registered manager, office staff and care workers. 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 10 people’s care records and multiple medicines records. We looked at 4 staff recruitment files and 5 staff supervision records. A variety of records relating to the management of the service, including audits, policies and procedures, training information, complaints, meeting minutes and questionnaire results were reviewed. We received feedback from 3 professionals who regularly work alongside the service.

Updated 7 March 2024

About the service

St Gregory’s Homecare Ltd is a domiciliary care service providing personal care. At the time of our inspection the service was supporting 77 people. The service provides support to older people and younger adults including people living with dementia, physical disabilities, sensory impairments, mental health conditions and learning disabilities.

Not everyone who used the service received personal care. The Care Quality Commission (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

The provider had made significant efforts following the last inspection to improve their quality monitoring and governance systems. Despite this, these systems had not been effective and further changes had not been embedded or sustained. People told us they experienced inconsistencies in their care visit times, with these taking place earlier or later than planned. This remained an ongoing issue from previous inspections. The registered manager was reviewing this and making changes but we could not be assured these would improve people’s experiences and outcomes.

People felt safe with the support they received. Risks to people were identified and managed and appropriate safeguarding processes were in place to protect people. People’s care visits were not always organised to allow sufficient gaps between medicine doses. The provider’s medicines audits were not always robust and identifying this shortfall.

People’s care was not always effective and did not always promote a good quality of life for people. People’s care visits were not always consistent and this affected the majority of people using the service. One relative said, “It can be very chaotic. The times are all over the place, [person] is constantly ringing to find out when the carers are coming.” Although staff had received training to support them in their roles, people and their relatives told us there were variations in the standard of care they received.

Staff provided kind, empathetic care to people. People and their relatives spoke positively about the approach by individual care staff. People’s dignity, privacy and choices were respected.

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.

Care plans reflected people’s preferences and helped staff provide person-centred care. People’s communication needs were met. Further work was needed to demonstrate how people had the opportunity to discuss their future care wishes. People and their relatives knew how to raise any concerns or complaints and gave mixed feedback on whether actions taken to address these were sustained.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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 7 February 2023) 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 the provider had addressed some breaches in regulation but 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.

Enforcement and Recommendations

We have identified breaches in relation to good governance 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.