Archived: ICare Solutions Manchester Limited

ICare Solutions is a domiciliary care service providing personal care and support to people living in their own homes. The service also works closely with healthcare commissioning teams in supporting people who have a range of healthcare needs. The hours of support vary depending on the assessed needs of people.

At the time of the inspection the service was supporting 75 people within the local community of Manchester and Stockport. We last inspected the service on 1 May 2014 when we found the provider was non-compliant in Regulation 12 of the Health and Social Care Act 2008.

There was a registered manager in post. 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.

People told us they received safe care, which was reliable and consistent. The service had sufficient staff to meet people’s needs, and people were given the time they needed to ensure their care needs were met.

We saw that people were protected from avoidable harm. During the inspection we checked to see how the service protected vulnerable people against abuse and if staff knew what to do if they suspected abuse. There was an up to date safeguarding vulnerable adult’s policy in place. Risks to people were assessed and risk management plans were in place. We found that the staff we spoke with had a good knowledge of the principles of safeguarding.

Risks posed to people were identified during the assessment process. Care plans we looked at contained information in relation to risks that had been identified for individuals, for example when mobilising or having medicines. Environmental risks had also been identified and documented for staff.

Staff were trained to administer medicines. The registered manager was in the process of implementing a more thorough Medication Administration Record (MAR) chart for more accurate recording of medicines. The management team acknowledged that the medicines management system could be more robust and agreed to re-visit their policy, ensure this was aligned to best practice and implement any changes they needed to make the system safer.

The service was not working to the principles of the Mental Capacity Act, 2005 and staff did not receive any formal training on MCA. The service was not assessing and documenting, where necessary, people’s ability to consent to care.

The service had robust recruitment processes which included the completion of pre-employment checks prior to a new member of staff working at the service. This helped to ensure that staff members employed to support people were suitable and fit to do so. People who used the service could be confident that they were protected from staff that were known to be unsuitable to work with vulnerable people. Staff knew their roles and responsibilities and were knowledgeable about the risks of abuse and reporting procedures.

We saw evidence of the induction process and there was on going training provided for caring roles and responsibilities.

People were supported with a range of services which enabled them to continue to live in their own homes safely. People we spoke with who used the service and their relatives told us they had been involved in the assessment and planning of the care and support provided and that the service responded to changes in people’s needs.

The care records contained information about the support people required. We saw documented evidence of people’s likes, dislikes and preferences and records we saw were complete and up to date.

We found from looking at people’s care records that the service liaised with health and social care professionals involved in people’s care if their health or support needs changed. The service worked alongside other professionals and agencies in order to meet people’s care requirements.

Likes, dislikes and personal preferences of people using the service were documented in care plans. People had been consulted and the service recognised the importance of documenting this information so that care and support provided was personalised, safe and correct for the individual.

There was an up to date accident/ incident policy and procedure in place. Records of accidents and incidents were recorded by care workers within communication books, however these were not always actioned at the office. The recording of accidents and incidents needed formalising.

The service had a complaints policy in place and we could see that people using the service were aware of how to make a complaint. Formal complaints were acknowledged and addressed within specified timescales.

Staff told us they felt they were able to put their views across to senior staff and to management and we saw examples of this from minutes of meetings and supervision records. The staff we spoke with told us they enjoyed working at the service and said they felt fully supported and listened to.

The service did not undertake spot checks on staff to observe behaviour and practice and the formal audits in place to monitor the quality of service delivery were not limited and ineffective. Feedback from people using the service and their relatives was gained via various sources. The service could evidence that it had acted on feedback to improve the care experience for people.

The overall rating for this service is ‘requires improvement’. During this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

An inspector visited this service on 10 September to carry out an inspection. We were also accompanied by a registration assessor for part of the inspection. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During this inspection we spoke with five relatives, seven care staff, the director and the acting manager of I Care Solutions Limited. The registered manager was not available on the day of our visit and we were informed by the director an acting manager was in post. We were also told the acting manager was currently receiving a handover from the registered manager. As part of this inspection we also visited three people in their own homes. Below is a summary of what we found.

Is the service caring?

The people we spoke with were happy with the care and support provided by I Care Solutions Manchester Limited. Comments included; "Staff treat me and my home with respect.”, and “I’m happy. I would tell them if I wasn’t happy.” We spoke with five relatives who also told us they found the staff to be caring. Comments we received included; “Staff are very good.”, and “The carer is excellent.”

Is the service responsive?

We were told by the acting manager people were encouraged to give feedback through telephone calls and at care meetings. We were also told questionnaires and surveys were not currently offered to people who used the agency but these would be introduced. However we concluded improvements were required to enable the agency to effectively monitor the quality of the service provided and introduce improvements if required.

Is the service safe?

We saw some systems were in place to ensure people were safe. We saw there was a safeguarding policy in place however this did not contain contact numbers for appropriate authorities. We spoke with seven staff and from our conversations it was clear not all staff knew who to report safeguarding concerns to. It is important staff know how and who to report concerns to as this minimises the risk of harm and abuse. We considered improvements were required to ensure allegations of abuse were responded to appropriately.

We also found appropriate recruitment checks to ensure the suitability of staff employed by the agency had not always been carried out. In one staff file we saw no evidence to show a Disclosure and Barring Check (DBS) check was in place or had been completed prior to the person starting work. In addition two staff we spoke with informed us they had not been formally interviewed prior to starting work with the agency and DBS checks had not been provided to the agency or received prior to the staff delivering care to people who used the service. We concluded improvements were required as sufficient recruitment checks help ensure unsuitable people are not employed to work with vulnerable people.

Is the service effective?

We saw no evidence in two care records that some people’s health needs had been assessed or care had been planned to meet their needs. The manager told us that they would review the care provided and update the care records to reflect people’s current needs. We considered improvements were required to ensure people received effective care.

Is the service well led?

The service had a manager in place who has been registered with the Care Quality Commission since June 2014. At this inspection the registered manager was not present. The CQC had been informed by the director of the company that the registered manager was leaving and an acting manager was currently in place.

We asked the acting manager and the director what audits were in place to identify, assess and manage risks relating to the health, safety and welfare of people who used the service. For example audits of timekeeping, medication and care records. We were told there were currently no audits carried out. We asked to see any previously completed audits and were told these had not been completed. We considered improvements were required to ensure risks to people who use the service were promptly identified and action taken to minimise risk.