Choice Care 4 U Services Ltd

Choice Care 4U is a domiciliary care agency. The service provides personal care to people living in their own homes in Selsey and Bognor Regis. At the time of the inspection 43 people were receiving the regulated activity of personal care. Some people were living with dementia, learning disabilities, neurological and health conditions and general frailty.

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

Improvements had been made to quality monitoring of the service. Further development of quality monitoring and governance processes were required to ensure these were effective. A service improvement plan had been implemented to address the concerns found at the last inspection and we were able to see improvements made.

The registered manager had worked hard to make service improvements and meet the required level of compliance. People and their relatives were happy with the service they received. Feedback from people included " I am very happy with the service I am receiving," and "The staff treat me with kindness and respect". Staffing levels were enough to meet people’s individual needs. 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.

Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns. People told us they received a safe with the service and did not have reason to doubt staff skills, integrity or honesty. Processes had been implemented to ensure support plans and risk assessments contain detailed and person-centred information. Risks to people's health and wellbeing were managed. Medicines were administered safely.

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.

Based on our review of key questions safe and well-led the service was able to demonstrate how they were meeting the underpinning principles of Right support, Right care, Right culture.

Right support: The model of care maximised people's choice, control and Independence and measures had been taken by the provider to meet the needs of people with a learning disability in line with best practice guidance. Care plans identified which aspects of their care people could manage themselves or the type of support people required in order to promote their independence.

Right care: People with a learning disability received person-centred care and the support people received promoted dignity and equality. People's needs and preferences were known and respected.

Right culture: The ethos and values of the service ensured people using services were empowered to have choice and control over their lives. Staff had received training to ensure they had the skills and abilities to meet people's needs.

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 24 January 2022) and there were breaches of regulations. 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 24 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out an unannounced comprehensive inspection of this service on 9 December 2021. Breaches of legal requirements were found in relation to providing safe care and treatment, medicines, protecting people from harm, staffing and the management of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check the provider had followed their action plan and whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe 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 Choice Care 4 U Services Limited on our website at www.cqc.org.uk.

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

Choice Care 4U is a domiciliary care agency. The service provides personal care to people living in their own homes in Selsey and Bognor Regis. At the time of the inspection 50 people were receiving the regulated activity of personal care.

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

There was a failure to assess and mitigate risks to people. Care records lacked important detail to guide staff on how to make people safe. Support plans did not contain detailed and person-centred information and therefore these did not always accurately reflect the needs of those who used the service. There were shortfalls in the way people’s epilepsy, medicines and mobility were managed. People did not always receive support in line with best practice guidelines.

There was not an adequate process for assessing and monitoring the quality of the services provided and ensuring that records were accurate and complete. There was a lack of provider oversight and governance of the service. Processes were not in place to review accidents and incidents and learn lessons to drive service improvements. The provider had not ensured staff were recruited safely and there was a failure to ensure staff undertook training and were suitably skilled and knowledgeable for the role.

People were happy with the care they received and felt safe with the staff that were supporting them. People told us they received a reliable service and calls were never missed. Staff told us it was a good place to work and the enthusiasm from the team impacted positively on the people using the service. People said they received support from a consistent team who knew them well. There were enough numbers of staff to ensure people did not feel rushed and people received their support on time.

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.

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.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, Right care, Right culture.

Right support: The model of care did not maximise people's choice, control and Independence and measures had not been taken by the provider to mitigate this. The provider was unable to demonstrate how they met the needs of people with a learning disability in line with best practice guidance.

Right care: There was a lack of person-centred care and the support people received did not promote dignity and equality. People's needs and preferences were not always known or respected. Care plans did not clearly identify which aspects of their care people could manage themselves or the type of support people required in order to promote independence and aid communication. People did not always receive safe care.

Right culture: The ethos and values of the service did not ensure people using services lead confident, inclusive and empowered lives. People were not empowered to have choice and control over their lives. Staff had not received training to ensure they had the skills and abilities to meet people’s needs.

We sign posted the provider to the Right support, Right care, Right culture information on the guidance for providers page on our website

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 (published16 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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 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 providing safe care and treatment, medicines, protecting people from harm, staffing and the management of the service at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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 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.

Choice Care 4 U Services Ltd provides care for people in their own homes. At the time of our inspection Choice Care 4 U Services Ltd was providing care to approximately 72 people with a range of needs including older persons, people with mental health needs and those living with dementia. People were supported with personal care as well as support for domestic tasks and shopping.

The service was last inspected in March 2016. At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People receiving the service had a range of needs and told us they received personalised care at home that was caring, supported them to be as independent as possible and to live healthier lives.

People and their relatives felt safe using the service and that staff knew how to provide safe care and treatment. Risks to people’s health and safety were appropriately assessed and mitigated. Guidance was provided to staff on how to manage people's risks. Staff had a good understanding of people’s needs and staff communicated well amongst each other and with external professionals to stay up to date with any changes in a person’s needs.

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 support this practice.

People continued to receive personalised care that was reliable and supported people to receive personal care in their own home. People and relatives told us they felt listened to, complaints were managed and responded to appropriately.

Staff had been trained to recognise the signs of potential abuse and knew what action to take if they suspected abuse was taking place. Safe recruitment practices were in place so that suitable staff were engaged to work in the care profession. Accidents and incidents were reported and managed appropriately.

People's medicines continued to be managed safely by trained staff. Staff supported people to prepare meals and ensured people had sufficient to eat and drink.

People and relatives told us that staff treated them with dignity, respected their privacy and made them feel comfortable and at ease with the staff.

People were involved in their care and support and were encouraged to be active in giving feedback about how the service was run. People were asked for their views about the service through surveys sent by the provider and when their care plan was being reviewed. The service demonstrated good management and leadership and staff felt supported to raise any concerns they had.

People's health needs continued to be monitored well and staff were responsive in seeking treatment. A community health professional told us staff were quick to spot changes in a person’s health and to alert the person’s GP or district nurse.

The service was well led by the deputy manager and registered manager. Governance and quality assurance systems were effective to monitor the quality of care. Staff were supported to have access to mandatory and additional training including formal qualifications.

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 and associated Regulations about how the service is run.

People received a reliable service from regular staff. There were sufficient numbers of suitably experienced staff employed to meet people’s needs. Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people who may be at risk.

People were supported by staff to take their medicines and this was recorded in their care records. Checks were carried out to ensure staff were competent to administer medicines and that staff were following the correct procedures.

People, and their relatives, said they felt safe with the staff. There were policies and procedures regarding the safeguarding of adults. Staff were aware of the correct procedures to follow if they considered someone was being neglected or poorly treated.

Suitable training, support and induction was provided for staff so they could support people effectively. Staff told us they received regular training and that they had a good induction before they started to provide support to people.

Each person had a care plan which gave guidance to staff on supporting people safely. Risks to people were assessed and recorded. These included environmental assessments for people’s homes so staff knew any risks and what they should do to keep people and themselves safe.

Staff received training with regard to the Mental Capacity Act (MCA)) 2005 and associated legislation. People told us their care workers obtained their consent when providing care and support.

People were supported to eat and drink in line with their individual needs. The agency supported people to access healthcare professionals when needed.

People told us they were supported by staff who were kind and caring. People were able to express their views and were encouraged to be independent as possible. People said they were treated with dignity and respect. A complaints procedure was in place that enabled people to raise concerns and people were aware of this.

People said their needs were regularly reviewed and they were contacted on a regular basis to ensure that their current up to date needs were being met.

The provider had a policy and procedure for quality assurance. The registered manager and senior staff carried out checks to help to monitor the quality of the service provided. Quality assurance surveys were sent out to people, relatives and staff each year by the provider to seek their views on the service provided by Choice Care 4 U Services Ltd.