24-7 Care Services

24/7 Care Services is a domiciliary care service, providing the regulated activity of personal care. The service provides support to older adults, people with a physical disability, people with a learning disability, younger people and people living with dementia. At the time of our inspection there were 11 people using the service.

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.

At the time of the inspection, the service did not care or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support

People told us they felt safe when supported by care staff and were happy and complimentary about their care. Systems were in place to protect people from harm and staff were aware of the risks to people, however care records were not up to date and did not always reflect people’s current needs. People were supported by safely recruited staff who knew their care needs well.

Right Care

People were supported by staff who understood how to protect them from poor care and abuse. Staff had received training in how to recognise abuse and knew what actions to take in those circumstances. The provider worked alongside other agencies to keep people safe and assist them in accessing effective care and support. People were supported by a consistent group of staff who had received training in how to support them safely and effectively.

Right Culture

People confirmed their care needs were regularly assessed. We found some areas that required improvement that the provider’s own audits had not identified. These were in relation to ensuring information held in people’s care records was up to date and correctly risk assessed, medication audits were effective and protocols were in place to guide staff on the circumstances in which to administer ‘as required’ medicines. People told us they had no issues getting hold of the management team and they were regularly contacted to ensure they were happy with the service they received.

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 (published 5 January 2018).

Why we inspected

We inspected this service due to the length of time since the previous inspection. We completed a focussed inspection of the key questions safe, effective and well led. For those key questions not inspected, we used the rating awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 24/7 Care Services on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

At our last inspection on 17 January 2017 we found two breaches of legal requirements which were, good governance and, failing to notify CQC of statutory notifications. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service. At this inspection we saw improvements had been made and the provider was now meeting the legal requirements.

At the last inspection we rated the service as requires improvement in three key questions which were, safe, effective and well-led. This was because the registered manager had not understood their responsibilities for reporting safeguarding concerns to the CQC, their responsibilities for ensuring they practiced in-line with The Mental Capacity Act 2005 (MCA) and did not have robust checks in place to ensure the service was delivering high quality care. We found the improvements the registered manager had put in place had now been sufficient to rate these key questions as good.

24/7 Care Services is a domiciliary care agency. They provide personal care to people living in their own houses and flats in the community. They provide a service to older adults, younger disabled adults, and people who have dementia. At the time of our inspection 17 people received personal care in their own homes.

Not everyone using 24/7 Care Service receives the regulated activity, personal care. CQC only inspects the service which provides ‘personal care’ to people, such as, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in place at the time of our inspection; the registered manager was also the provider of 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.

People told us they received safe care, relatives who we spoke with felt staff were trained to support their family members in a way which kept them safe. Staff demonstrated good knowledge in how they were to protect people from harm. Staff recognised the signs of abuse and knew how to report this. The registered manager had identified potential risks to people and had put plans in place to support staff to reduce the risk to people without taking away people’s right to make decisions about their care. People and relatives told us the registered manager ensured there were enough staff to support their care needs. Staff told us that because the service supported a small number of people, they were able to deliver safe care and support to people. People were supported with their medicines in a safe way.

People received care and support which met their needs and preferences and was in line with their consent and agreement, and staff understood the importance of this. We found people were supported to eat a healthy diet which was tailored to their individual preferences. Staff worked with external healthcare professionals and where necessary followed their guidance and advice about how to support the person in the right way.

People’s views and decisions they had made about their care were listened to and staff acted upon these in a dignified and respectful way. Relatives felt the staff team treated their family members in a kind and friendly way, which was done so respectfully.

The registered manager had provided people with information around how to raise a complaint should they need to. People and relatives we spoke with had not needed to raise any concerns but knew how to do this should they need to. The registered manager had not received any complaints at the time of our inspection. The registered manager told us that they had regular contact with people which they felt reduced the likelihood of people needing to complain about the service provision.

People and their relatives felt involved in the way the service was run. They felt they had the opportunity to share their views and discuss aspects of the service. Staff felt supported by the registered manager to carry out their roles and responsibilities effectively, through training and daily contact. Staff felt involved in the service and felt able to influence their ideas in the way in which the service was run. People, relatives and staff felt the registered manager was approachable and listened to them. We found checks the registered manager completed on the service focused upon the experiences of people.

24-7 Care Services provides personal care and support to people living in their own homes. At the time of our inspection there were 15 people using the service.

There was a registered manager in post 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.

This was the first inspection of this service since it was registered in January 2016.

The provider was not keeping us informed of incidents that they are required to inform us about.

People received a service in which they had confidence. However, the appropriate processes were not in place to ensure consistent monitoring of the service and to ensure people received a service that was consistently well led.

Safe procedures were not in place to fully assess the risks associated with people’s care. This included assessing the risks of supporting people with their medicines and taking into account all risks associated with offering care and support to people.

People were not fully supported to have maximum choice and control of their lives, so that they could be assured they were support in the least restrictive way possible. This was because, where people were not able to make informed decisions about their care the correct process was not in place to support them and staff were not trained to ensure they fully understood how to fully protect people’s rights.

People were supported to maintain their diet and health needs where required. Staff were caring and people’s privacy, dignity, independence and individuality was respected and promoted by staff and the management.

People received a reliable service, there were sufficient numbers of staff to ensure people’s needs were met and that care visits were not missed. The provider mostly undertook the relevant checks before staff were employed and people were complimentary about the quality of the staff that supported them. However, minor improvements were needed in the recruitment process to ensure only suitable staff were always employed in the future.

People were confident that staff had the skills to meet their individual needs and support them in the way they wanted. We found that staff had received most of the training they needed to meet the needs of people that used the service. Staff felt supported in their role; however, a more formal process for the frequency of how staff are supported needed to be put in place, to ensure staff remained effective in their role.

People were able to raise their concerns or complaints and their complaints were acted upon, so people could be confident they would be listened to and their concerns resolved to their satisfaction.

You can see what action we told the provider to take at the back of the full version of the report.