Caerus Care Limited

Updated 16 August 2023

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

This inspection was carried out by two inspectors.

Service and service type

This service is a domiciliary care and supported living agency. It provides personal care to people living in their own houses and flats and supports people who need support to promote more independence.

Inspection activity started on 19 July 2023 and ended on 28 July 2023. We visited the location's office on 20 July 2023. We provided initial feedback about our inspection findings on 31 July 2023.

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 the Care Quality Commission (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 announced. We gave the provider 48 hours' notice as the registered manager could be out of the office. We wanted to be sure they would be in.

What we did before the inspection

We reviewed information we had received about the service since the service was first registered. 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 1 person who used the service and 5 people's relatives by telephone. Not everyone using the service was able to speak with us so we used staff to help with their communications. We visited one person in their home. We received feedback from a social worker, the local authority contract monitoring team, and the local safeguarding authority. We also spoke with 10 members of staff including the nominated individual who was also the registered manager, the quality manager, the deputy manager, senior care staff and care staff. 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 6 people's care records. We looked at their medicines' records and 3 staff files in relation to recruitment. A variety of records relating to the management of the service were also reviewed, including incident records, compliments, complaints, quality assurance processes, audits, policies and procedures.

Updated 16 August 2023

Caerus Care Limited is a domiciliary care agency and supported living service. At the time of our inspection 35 people were being supported in their own home, 10 of whom were supported with personal care. The service provides support to younger people, people with a learning disability or autistic spectrum disorder, people with a physical disability and people with a mental health condition.

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. Just prior to our inspection starting the provider had moved to a new address.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted.

'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Based on our review of is the service safe, effective and well-led questions, the service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support

Some risk assessments were not recorded and care plans lacked detail how staff should manage risk. Medicines administration records did not always reflect safe medicines administration. People were supported to have maximum choice and control of their lives and staff supported them with decisions that were in people’s best interest. However, a lack of recorded best interest decisions, meant there was a risk that the restrictions in place might not be the least restrictive.

Some audits were not as effective as they could have been, such as for the detail in care plans and risk assessments, medicines administration, mental capacity assessments and best interest decisions.

The nominated individual who was also the registered manager addressed these matters promptly, but until we highlighted these, actions had not been taken. Staff however were clear on exactly how to administer these medicines in a specific way and supported people with their medicines in a way that respected their independence.

We have made a recommendation in the well-led section of this report for the provider to seek support and ensure that audits and records are accurate and up to date and reflect care in people’s best interests.

Staff supported people to be cared for as safely as practical. Staff complied with measures designed to reduce the risk of infections spreading. Staff focused on people's strengths and promoted what they could do, enabling the opportunity for people to lead fulfilling and meaningful lives. One relative told us how proud they were at what their family member had achieved and how happy and settled they now were.

Staff supported people to achieve their goals and go on to further achievements. A staff member said, "Seeing [person] now safely at home with the right equipment means they are making good progress in their own time but with some support, regaining their independence."

Staff received effective training in the use of restraint and were confident in their ability to deploy this training should it ever be needed. At the time of our inspection no person required physical restraint. Any restraint would be in an emergency situation as a last resort and for the shortest time possible. Staff supported people to make decisions following best practice in decision-making.

Right Care

Staff focused on and promoted people's equality and diversity, supporting, and responding well to their individual needs. This changed people's lives for the better. One person said, “My life has been changed so much. I can travel independently.” Staff’s perseverance in listening to what the person wanted. One relative told us how much more their family member could now do and how well staff understood their communications in ensuring the person was given equal opportunities.

People or their legal representative helped create and review their care plans when they chose to, and as such were a reflection of the support they needed and what people could do independently. Staff had training on how to recognise and report abuse, and had the skills to help protect people from poor care and abuse, or the risk of this happening. The service worked with other agencies to do so.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. All those we spoke with felt people were safe and had enough support to do this. Staff's diligence and persistence enabled people to achieve their aspirations. People lived a meaningful life and staff supported people to gain independent skills. People were supported to communicate in their preferred way including a few words and visual prompts.

People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. One relative told us the service always went the extra mile and said, “They go above and beyond. Staff have transformed my [family member’s] life. They used to be calling me on the phone all the time, but now they are settled and so happy there. If there were any concerns they would ring me but they have told me they love it.”

Right Culture

People were supported by staff who understood best practice in relation to people's strengths, impairments, or sensitivities for people with a learning disability and/or autistic people may have. Staff knew people well and responded to their needs and wishes. One relative told us the service had made a huge difference to their family member saying, “I am not generous in giving accolades but I can only speak good of them. They go over and beyond. I can’t praise them enough.” Staff put people's wishes, needs and rights at the heart of everything they did. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

People, relatives, staff and health professionals had a say in how the service was run. The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service led confident, inclusive and empowered lives.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was also prompted due to concerns about the management of risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We have found evidence that the provider needs to make improvements. Please see the well-led sections of this full report. 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 good 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 Caerus Care Limited on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.