We carried out a review of the data available to us about 121 Care Agency Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about 121 Care Agency Limited, you can give feedback on this service.
121 Care is a domiciliary care service delivering care and support to people in their own homes living in West Cumbria. At the time of the inspection the provider was supporting approximately 120 people, mainly older adults. 121 Care delivers personal care and also cares for people who may be at the end of life. They also support some people with basic home nursing tasks that have been delegated to them by the community nurses.
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
People told us they felt safe. Staff had received suitable training about protecting vulnerable adults. Good arrangements were in place to ensure new members of staff had been suitably vetted. Accidents and incidents were responded to appropriately.
Staff were appropriately inducted and developed. Team members understood people's needs and had suitable training and experience in their roles. The service employed enough staff to cover the programme of calls in all areas.
Staff supported people to get health care and staff managed medicines well. The service had good working relationships with health care professionals. Staff supported people to eat well and stay hydrated.
The staff team were aware of their responsibilities under the Mental Capacity Act 2005. 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 supported this practice.
People told us the staff were caring and respectful and made sure confidentiality, privacy and dignity were maintained.
Risk assessments and care plans provided detailed guidance for staff. People using the service, or their relatives, as appropriate, had influenced the content. The provider/registered manager ensured the plans reflected the person- centred care that was being delivered.
Staff could access specialists if people needed communication tools like sign language or braille.
The service had a quality monitoring system and people were asked their views in a number of different ways. Quality assurance was used to support future planning.
The provider/registered manager understood how to manage concerns or complaints appropriately. There had been no recent complaints.
Records were well organised, easy to access and stored securely.
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 (21st April 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
Our last comprehensive inspection of this service was carried out in October 2015. At that inspection we found breaches of legal requirements relating to the management of allegations of abuse, staff training in safe moving and handling, care planning, managing complaints, support for staff and monitoring the quality of the service.
We undertook focused inspections of the service in March and June 2016 to check if the registered provider had taken action in response to concerns we identified at the comprehensive inspection. At the focused inspections we found that the registered provider had made the required improvements and they were no longer in breach of legal requirements.
At our comprehensive inspection in January and February 2017 we saw that the actions taken to improve the service had been sustained and people received safe care that met their needs.
121 Care provides personal care and support to adults living in their own homes. The agency is based in offices in Cleator Moor and provides support to people in the Copeland district of Cumbria.
The registered provider was an individual who also managed the service on a day to day basis. Registered providers 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 received the support they needed from staff who were trained and skilled to deliver their care.
Care staff treated people in a kind and caring way and people looked forward to the staff visiting their homes.
People received their care in a way that protected their privacy and dignity. Care staff asked people for their consent before providing their care and supported people to maintain their independence.
Hazards to people’s safety had been identified and actions taken to manage risks. People received their medicines safely and were supported, as they needed, to see their doctor.
The registered provider understood her responsibilities under the Mental Capacity Act 2005 and people’s rights were protected
Thorough checks were carried out before new staff were employed to ensure they were suitable to work in people’s homes.
People knew the registered provider and how to contact her. People were asked for their views and action was taken in response to their feedback. Where issues were raised with the registered provider she took action to resolve people’s concerns.
The registered provider had good systems to monitor the quality of the service.
We had previously carried out an unannounced comprehensive inspection of this service on 14 October 2015. Breaches of legal requirements were found. We served a notice in December 2015 under Regulations 12(1) and 12(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment because of a failure to provide suitable assessment and planning for care delivery.
At this time we also served a notice under Regulation 17(1) and (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance because systems in place to check on the quality of the service were not functioning appropriately and suitable quality standards were not being met.
We then carried out a focussed inspection of the service on 3 March 2016 where we judged that the provider had met legal notices serviced on them.
We undertook this focused inspection on 28 June 2016 to check that the provider had now met legal requirements in relation to the other breaches identified at the comprehensive inspection. This report only covers our findings in relation to these breaches. You can read the report from our last inspections, by selecting the 'all reports' link for on our website at www.cqc.org.uk.
121 Care deliver personal care support to people in their own homes. At the time of this inspection they were delivering care to approximately 60 people. They operate in the Copeland area of Cumbria.
The registered provider is also the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At this focussed inspection we looked at the domain 'Effective' and we checked on the remaining two breaches of legislation. The registered provider had been in breach of Regulation 12 (2), because untrained staff were dealing with moving and handling equipment and manoeuvres which might endanger them and the service users.
We also checked on the breach of Regulation 18(1) and (2), which had identified that not all team members were suitably supported to develop in their job role.
After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this visit on 28 June 2016 to determine whether these two compliance actions had been met and to establish a rating for 'Effective'.
We judged that the registered provider/manager had addressed all the issues that we had found at the comprehensive inspection in October 2015. We also judged that the changes had been sustained over a longer period. There had been enough progress to rate 'Effective' as Requires improvement.
One of the issues was around the management of moving and handling of people who needed support with their mobility. We saw evidence to show that every person who needed this kind of support had suitable moving and handling plans in place, all staff had received training and their competency checked.
We also looked at staff development. We saw that staff had received suitable levels of support. New staff were given induction to their role and had on-going training and development. We saw that staff also received regular supervision and that all of the staff had gone through an annual appraisal. We judged that some of the records related to supervision would benefit from a little more detail.
We recommended that supervision notes recorded the discussions in more depth so that an accurate record of the details of supervision would be easily accessible.
People were asked for consent and their wishes adhered to in relation to the support they wanted.
People were given suitable support to maintain good levels of nutrition and hydration.
The staff team contacted health care professionals when there was any kind of health concern.
The business was run from suitable premises.
We had carried out an unannounced comprehensive inspection of this service on 14 October 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.
We served a notice in December 2015 under Regulations 12(1) and 12(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment because of a failure to provide suitable assessment and planning for care delivery.
We also served a notice under Regulation 17(1) and (2)of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance because systems in place to check on the quality of the service were not functioning appropriately and suitable quality standards were not being met.
This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection of 14 October 2015 had been made. The team inspected the service against two of the five questions we ask about services: is the service Responsive and Well-led. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for on our website at www.cqc.org.uk
The inspection was carried out by the lead adult social care inspector. We gave the provider two hours notice of our visit to make sure she would be in the service.
121 Care deliver personal care support to people in their own homes. At the time of this inspection they were delivering care to approximately 60 people. They operate in the Copeland area of Cumbria.
The registered provider is also the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
We saw evidence to show that the provider had ensured through assessment, care planning and review that people were in receipt of safe care and treatment. We had received an action plan detailing the changes made in the service. We had confirmation from the local authority and from the health care commissioning body who also judged that the service was now delivering care in a safe way.
We also saw that the quality monitoring systems in the service had been improved and that the provider was able to monitor quality and deal with any problems with the quality of the care delivery. We also learned that the provider was now working closely with health and social care providers to ensure the delivery of care was of an acceptable standard.
We judged that these two domains had improved since out visit in October 2015 when we judged the outcome to be 'Inadequate'. We saw enough evidence to show that these areas of concern had been dealt with appropriately and we adjusted the rating for the domains 'Responsive' and 'Well-led' to 'Requires improvement'. We also looked at the overall rating for the service. We adjusted the overall rating to one of 'Requires Improvement'. To achieve a rating of 'Good' would require a longer term track record of consistent and sustained good practice in all areas. We will check this during our next planned inspection.
This was an announced inspection which took place on 14th October 2015. This was the first inspection since the service was registered on 17th September 2014.
121 Care deliver personal care support to people in their own homes. At the time of the inspection they were delivering care to approximately 60 people. They operate in the Copeland area of Cumbria.
The registered provider is also the registered manager. 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.
We discovered that two incidents which may have been safeguarding matters had not been reported to the local authority or to the Care Quality Commission.
This meant that the service was in breach of Regulation 13: Safeguarding service users from abuse and improper treatment, because the provider had failed to notify relevant agencies of potentially harmful incidents.
The service had suitable numbers of staff to deliver the care hours however we recommended that the provider keeps the rostering of these staff under review to ensure that care delivery was logical and timely.
New staff were being recruited appropriately but some staff did not stay in the service for more than a few weeks. People in the service were unhappy about staff turnover. We asked the provider to look into her recruitment and retention processes.
We saw that there had been some problems in the way medicines were being managed. These matters had been dealt with by the provider to prevent a re-occurrence.
Suitable infection control systems were in place but we had evidence to show that some staff did not use disposable aprons. We asked the provider to deal with this to prevent cross infection.
Some staff were helping people to move using equipment and they had not received training. When we visited there was no one trained to assess staff competence in this or to develop moving and handling plans.
This is a breach of Regulation 12 (2) because some moving and handling was not being done correctly in the service.
We saw that supervision and staff development needed to be improved. Staff needed more support to improve their skills and knowledge.
This is a breach of Regulation18 (1) (2), because staff needed more support to develop in their role.
People told us that the staff team were kind and caring and supported them to receive dignified care.
We found that some packages of care were inadequately assessed and that care planning lacked detail. These care packages were for people with complex needs.
This is a breach of Regulation 9: Person-centred care, because assessment of need and planning for care delivery were incomplete or lacked detail.
We looked at complaints management and we found that although there was a suitable complaints process some complaints had not been handled appropriately.
This is a breach of Regulation 16, because two complaints had not been dealt with appropriately.
We found that there had been some problems with communication between the local hospital and the service. We asked the provider to improve this and to gain more information about assessed needs.
The service had a registered provider who managed the service. She was suitably qualified and experienced to run a domiciliary care agency.
The provider had failed to notify us of two incidents of concern.
This is a breach of the registration regulations and this matter is being dealt with outside the inspection process.
The service did not have a functioning quality monitoring system. Records did not always reflect the way the service was operating.
This is a breach of Regulation 17: Good Governance, because quality of the service had not been consistently monitored. Records management was not appropriate to support good governance.
You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.