Compkey Healthcare Ltd

Compkey Healthcare Ltd is a homecare service providing personal care to people within their own homes. 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. At the time of the inspection, 20 people were receiving personal care from the service.

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

Improvements had been made since the last inspection. People’s medicines were now managed safely, and they received them correctly. New staff had been subjected to the relevant checks to ensure they were of good character and safe to work for the service.

Staff had received training in various subjects relating to people's needs but their competency to ensure they understood this training had not always been adequately assessed. The provider had recognised the need to strengthen their assessments of staff competency and had already implemented some changes. However, further improvement was required to ensure staff understood all of the training they had received and therefore, we have made a recommendation in relation to staff training and supervision.

People received care that met their needs and preferences. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, some staff needed to improve their knowledge in relation to the Mental Capacity Act 2005. This was required to reduce the risk of people not receiving care in their best interests when they were unable to consent to it.

Risks to people’s safety had been assessed and staff knew how to support people to reduce these risks. However, people's records required more information to ensure staff had all the guidance they required to meet people’s specific risks. The provider agreed to immediately implement this. Systems were in place to protect people from the risk of abuse and there were enough staff to cover people’s care visits in line with their needs and preferences. Staff took precautions to reduce the risk of the spread of infection. Lessons had been learnt when things had gone wrong to improve the quality of care people received.

People received enough to eat and drink in line with their needs and were supported with their healthcare needs if required. The service worked well with other professionals to ensure people received effective care.

Staff were kind, caring and compassionate. They respected people’s privacy and treated them with dignity. People’s independence was encouraged, and an open culture had been developed within the service, where they could freely express their views when they wished to without fear.

Complaints and concerns were welcomed by the provider as an opportunity to learn. These were fully investigated, and people were involved in this process. People’s end of life wishes had been captured where they had wished to give this information, and staff worked with other professionals to ensure people’s wishes at this time were respected.

The provider had made improvements to their governance processes. The care provided to people was closely monitored and incidents or errors quickly identified and rectified. These revised governance processes need to be embedded within the service to ensure they remain effective. The provider demonstrated an appetite to continually improve the quality of care people received and was accepting of our findings of areas for improvement.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 9 September 2019). At that inspection we found three breaches of regulation. This was because the provider had not ensured people’s medicines were managed safely or their recruitment and governance processes were robust. Following that inspection, we imposed a condition on the provider’s registration telling them they had to send us a monthly report in relation to the monitoring of the quality of care people received. This condition was complied with and is in the process of being removed from the provider's registration.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

This service has been in Special Measures since 28 December 2018. 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 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.

Compkey Healthcare Ltd is a home care service providing personal care to people living in their own homes. At the time of the inspection, the service was supporting 16 people.

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

The provider had failed to improve the service adequately to ensure people received good quality care in all areas. Again, as we found at the last inspection, the governance systems they had in place had not been effective at ensuring people’s medicines were managed safely or that all the required checks on staff had been completed before they started working for the service.

This is the third inspection the provider has been in breach of regulations, demonstrating a lack of drive for improvement in all areas.

The provider had not checked to ensure relatives or friends had the appropriate legal authority to consent on behalf of a person where they had recorded this may be necessary. Information was not always in people’s care records to guide staff on how they needed to be supported with their care. This would reduce the risk of people receiving inappropriate care.

Some improvements had been made since our last inspection. People now saw more regular staff to enable them to build trusting and caring relationships with them. There were enough staff to meet people’s needs and people told us that care was delivered in line with their individual preferences.

People’s complaints and feedback were listened to and acted upon and systems and processes were in place to protect people from the risk of abuse. The staff were kind and caring and treated people with dignity and respect although further improvements were required to ensure all people received a caring service.

Staff used good practice to reduce the risk of spreading infection to people. They were vigilant about people’s health needs and reported any concerns to healthcare professionals when needed. The provider and staff worked well with other services to ensure people received support with their healthcare needs.

People had been involved in making decisions about their care. They 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.

Rating at last inspection:

The last rating for this service was Inadequate (published January 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also met with the provider to discuss our findings.

At this inspection some improvements had been made but not enough in all areas and the provider is therefore still in breach of some regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe management of people’s medicines, recruitment checks of staff, and current governance systems.

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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 six 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, 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection around 30 people were using the service.

There was a registered manager working at the service. 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. The registered manager at this service was also the provider and will be referred to as such throughout this report.

At the last inspection of this service, we rated the service overall as requires improvement. This was because people had not received good quality care and risks to their safety had not been managed well. This resulted in the provider being in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of care to at least good. At this inspection we found that the required improvements had not been made. The provider continued to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one regulation of the Care Quality Commission Registration Regulations 2009. Therefore, the overall rating for the service is now inadequate and the service in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will act to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The provider had continued to fail to ensure that robust governance systems were in place to monitor the quality and safety of care people received. Due to these poor systems, the provider could not be assured that people had received their medicines correctly. Also, people had been exposed to risks to their safety which had resulted either in actual harm or risk of harm.

Analysis of incidents, accidents and concerns raised had not taken place to promote a learning culture. CQC had not been notified of some incidents that we are required to be notified by law. Where we had been notified, this had not been completed in a timely manner.

The provider had not ensured there were enough care staff working for the service to cover the care visits required. This has resulted in office staff consistently covering these visits which impacted on their ability to monitor the quality of care being given to people.

Not all staff had received the appropriate training or supervision before they performed certain tasks such as giving people their medicines which put people at risk of unsafe care.

Care had not always been planned to meet people’s individual needs and preferences and people’s individual complaints had not always been recorded and investigated.

People told us the staff were kind, caring and treated them with dignity and respect however, some of the practices staff had used were not indicative of a wholly caring service.

Risks in relation to the spread of infection were managed well and people received enough food and drink to meet their individual needs. Checks on staff before they started working for the service to ensure they were of good character had improved, but needed further improvement to meet the required standards.

Consent was sought from people in line with the relevant legislation and people’s wishes at the end of their life met. The staff enjoyed working for the service and felt the management were approachable and open.

We have made a recommendation to the provider to check that a digital platform they are using for communication meets the required regulations.

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.

At this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report

The appropriate pre-employment recruitment checks had not always been completed for new staff, such as references and a DBS (Disclosure and Barring list check) before staff began working in the service.

Risk assessments were not always completed concerning people’s individual conditions and staff had not always followed recommendations from health care professionals.

Staff did not always receive adequate training to deliver their roles effectively. Some staff had limited English language skills which meant they were not always able to understand and communicate about training.

There were no effective quality assurance systems in place to assess, monitor and improve the service. Accurate records were not always kept in respect of people’s care. There were no systems in place to check that the content of care plans was relevant with enough individualised guidance for staff about people. Checking of staff competency had not been recorded, and it had not been identified where gaps were found in people’s recruitment files.

Staff did not all have knowledge of safeguarding and how to report concerns. Medicines were administered as prescribed, but improvements were needed around the care planning of some medicines taken as required (PRN).

Care plans contained information about the care that people required, however they were not always reviewed and updated. Care plans did not contain any information about people’s mental capacity.

There were enough staff to complete the visits planned. Staff were split into teams to ensure as much consistency as possible.

Staff were caring and respected people’s dignity, privacy and independence. They involved people’s families in the care planning and delivery where appropriate. Staff gave people choice and were flexible in their approach. However, there were not systems in place which ensured staff were caring and compassionate.

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 and relatives felt people receiving the service were safe. Risks to people were identified and responded to. Staff demonstrated an awareness of adult safeguarding and knew how to report concerns. Medicines were managed appropriately and there were checks in place to help ensure this.

People and relatives told us timing of calls could sometimes be an issue as sometimes staff were later than expected. Most people and relatives we spoke with told us this did not cause a significant problem. Where people required support with eating and drinking this was provided. Staff liaised with healthcare professionals, where appropriate, to ensure people received the health care required.

Most of the staff had received the training the provider had identified as mandatory. However, we found some occasions where staff had not received this training, although they had prior experience and training from previous roles. We have made a recommendation that the provider take action to ensure that staff working in the service has received the training that the service has identified is required.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interest and legally authorised under the MCA. Staff and the management team understood the MCA and how this impacted on the support they provided.

The provider had in place a clear ethos of providing compassionate and caring support. We found staff demonstrated these values. People and relatives confirmed that support was provided in a kind, caring, and respectful manner. Staff supported people to be as independent as possible and consulted them regarding the support provided.

People and relatives felt involved in the planning and provision of the support. The provider ensured staff knew people’s individual preferences and needs. Support was provided in a way that met these.

The provider responded to complaints and took action to resolve issues. People and relatives told us they knew how to raise complaints and felt comfortable to do so.

The service understood the importance of a positive culture. They had developed values and an ethos which included the manner in which they wanted staff to work. They took action to ensure sure staff understood this.

People and staff were involved in the service; their opinions and comments were listened to and used to help develop the service. Staff, people, and relatives, were positive about the registered manager and their leadership. The registered manager monitored the quality of the service and took action when needed.