5 Care Services Limited

5 Care Services Limited is a Domiciliary Care Service providing personal care to 96 people at the time of the inspection. The service supports people with mental health conditions, physical disabilities, dementia and older people. They are also registered to support children and people with a learning disability and autistic people. 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

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.

Right Support

People received the support they needed to keep them safe and ensure their needs were met. Staff were safely recruited and were available to support at the times people needed them. 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. People’s independence was promoted by staff who knew them well and encouraged them to achieve their goals and aspirations.

Right Care

People were supported by staff who were trained and had the skills and knowledge to meet their needs. Staff understood people’s individual communication styles and worked alongside families and other professionals to ensure their knowledge of people’s needs remained current. People told us staff were respectful when providing care and checked they were happy to receive care and support. There was a positive approach to risk management which supported people to live in the way they wanted to.

Right Culture

The provider had made improvements since the last inspection and this had positively impacted people’s experience of care and support. Systems had been developed to improve governance and oversight of the care provided and this identified any areas where improvements were required. The registered manager was open about the concerns identified at the last inspection and had shared learning with people who received support and the staff team. People, relatives and staff had been asked for their feedback and this had been used to drive improvement across the service.

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 2 May 2023) and there were breaches of regulation.

Following the last inspection, we imposed conditions on the provider’s registration. 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 27 April 2023. 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

We carried out an announced comprehensive inspection of this service on 20 January 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective, Responsive 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 good. 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 5 Care Services Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

5 Care Services is a domiciliary care agency registered to provide personal care to people living in 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, 123 people were receiving support with personal care. .

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

The provider had not ensured risks to people’s safety were assessed or managed. There were not enough staff on duty to meet people’s needs. The provider had not always protected people from abuse and improper treatment. The provider had not effectively analysed incidents and accidents and had therefore not identified how to help people to reduce the risk of the same thing happening again. The registered manager had not always ensured the safe and proper use of people’s medicines.

People’s physical, mental health and social needs had not always been holistically assessed to ensure effective outcomes of their care. The provider did not always liaise effectively with other agencies. Staff did not receive regular support.

Some staff told us they did not always have enough time to provide care and support in a compassionate and personal way. Staff knew people well. People we spoke with told us their privacy was respected and their dignity was upheld by care staff.

People were not always given information in a format they could understand. We received mixed views from people and their relatives regarding how the provider deals with complaints.

The provider failed to ensure effective systems and processes were in place to assess, monitor and improve the safety and quality of people's care. The provider failed to act on known risks to service users. Most care staff we spoke with told us there was a poor culture within the service. Team meetings were infrequent and unhelpful. The provider failed to act on feedback from people.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 requires improvement (published 17 September 2019). The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well-led sections of this full report.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified breaches in relation to person-centred care, safe care and treatment and good governance 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

About the service

5 Care Services is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection, 80 people were receiving care and support services.

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

People told us they felt safe and staff knew how to protect people from the risk of harm or abuse. People’s risks were assessed, monitored and managed. People were supported by enough staff that had been safely recruited. Medicines were given as prescribed. Staff had access to personal protective equipment. Accidents and incidents were monitored and reviewed. The registered manager informed us of incidents as required by law.

People were cared for by staff who had the skills and knowledge to meet their needs. Staff understood their role and felt supported by the management team. Staff sought people’s consent before care was provided. 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. People were supported to access healthcare agencies when required.

People told us staff were kind in their approach. People told us their dignity and privacy were maintained and they were involved in the planning and review of their care.

People received care that was responsive to their needs. Care records were reflective of people’s support needs and were up to date. The provider had a complaints process in place which people were aware of and knew how to access.

The provider had quality, auditing and monitoring systems in place which included competency checks on staff practice. People and staff said the provider and management team were approachable and the culture of the organisation open and friendly.

The registered manager through monitoring the service had identified that in certain areas of the governance of safety arrangements were required. These included risk assessments and peoples individual care records. The process to complete these developments had commenced and the provider had employed a compliance manager to enable continual improvements and consultant to continually develop the service, to ensure people received a well-managed service and good care.

Rating at last inspection

The last rating for this service was good (published 16/06/2016. At this inspection the rating has changed and now require improvements.

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

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

There was a registered manager in place at the time of our inspection. 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 their relatives to us they felt safe whilst receiving care. Staff had received training and were knowledgeable about how to keep people safe and were knowledgeable about how to report any concerns about people’s safety or if they suspected any abuse. Staff knew how to manage people’s assessed risks however these were not always recorded in their care records. People told us they were supported to meet their needs by sufficient staff, who stayed the correct amount of time. The provider had a safe recruitment process in place which ensured people were supported by appropriate staff. People received their medicines on time.

People and their relatives told us the staff who supported them had been trained appropriately to meet their needs. The registered manager and staff understood how the principles of the Mental Capacity Act (MCA) affected people’s care when they did not have capacity to make decisions about their care themselves. When people required support to meet their nutritional needs staff provided the support they required. People were supported to access outside health professionals when their health needs changed.

People told us they were supported by kind and considerate staff who knew them well and understood their needs. People and their relatives told us they were involved in agreeing how their care needs were to be met and received regular reviews of their care. Care records were up to date and reflected their current care needs. People were supported to maintain their independence. People told us staff respected their privacy and dignity. Staff were able to give us examples of how they ensured people’s privacy and dignity was maintained.

People told us staff provided care which was responsive to their individual needs. Staff gave people choices about their care and respected their preferences when care was delivered. People knew how to complain and when they did they were listened to and action taken to resolve their complaint.

People told us the service was well led and they would recommend the service to other people. Staff were happy working in the service because they were well supported by the registered manager. Some systems were in place to monitor the care people received. The registered manager was looking to introduce systems to look at further monitoring the care people received across the service.

During the inspection we spoke with the registered manager, the managing director and one member of care staff. We telephoned and spoke with two care staff, two people who used the service and four relatives after our visit to the office.

We saw that there were arrangements in place to gain people's consent to the care and support they required. People told us they received the care they wanted and needed, records we saw also confirmed this. One person who used the service told us: "They are brilliant and so caring". One relative said: "They are a very professional organisation". Another relative said: "I have peace of mind and when we are not there I know they are being looked after".

Staff received training and support to provide people with the support they needed. They had completed induction training when they started work and had undertaken additional training to develop and improve their knowledge and skills.

The service had systems in place to review and monitor the care people received.

The service had appropriate systems in place to enable people to raise concerns and be confident that their concerns would be investigated and addressed.

The service had required systems in place to ensure that staff were aware of abuse and actions they should undertake to respond to any allegation of abuse.

We found there were effective arrangements in place to ensure that only staff of good character were employed.

The service was compliant with the regulations and had met the requirements of the warning notice in relation to the employment of staff.

We found that required improvements had been made to ensure that staff received safeguarding training and were aware of action needed to protect people from harm. Staff we spoke with were aware of the signs of abuse or potential abuse and action they should undertake to protect people. We found that the service had required policies in place which informed staff about required standards of practice to protect people from abuse. We saw that these policies were also available within staff handbooks which each staff member confirmed they had received.

We found that required improvements had been made to protect people against the risks associated with unsafe management of their medicines.

The service had failed to ensure that the recruitment procedures for staff were effective and that only staff of good character were employed.

People were treated with respect and had their privacy and dignity promoted. A relative said, "They always treat X with respect and make sure X is covered up".

The service was responsive to people's needs and had care records in place which provided staff with information about people's needs and how they should be met. A relative told us, "Staff are flexible and frequently stay longer than the allocated call time". Another relative said, "Staff go beyond expectations, nothing is too much trouble". Another relative said, "The staff member who looked after mum was so good she was very much part of the family".

Staff had all received safeguarding training. Further training will provide ongoing assurance that staff would know and undertake required actions to keep people safe when needed.

Improvements were needed in relation to the management of medicines to ensure that people received their medicines safely to promote their health and wellbeing.

Pre employment checks were not sufficient to protect people who use the service from unsuitable staff supporting them.

Systems were in place to check and monitor the quality of the service provided. One relative said, "I would definitely recommend them to others who needed care", another relative told us, "I have already recommended them to others".