Careessence

Careessence is a domiciliary care agency providing personal care to people living in their own homes or flats. The domiciliary care agency is registered to provide a service to people over and under the age of 65 years. The agency also provides 24-hour live-in care and support.

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, one person was using the service who was receiving 24-hour care and support.

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

Risk assessments were not robust to ensure people received safe care. Care documentation was not always personalised and at times was contradictory or unclear. The provider’s quality assurance framework failed to identify shortfalls with documentation or recognise how improvements could be made. Best practice guidance had not always been followed and medicine care plans lacked information on the medicines prescribed and potential side effects. We have made a recommendation about the management of medicines.

Relatives were happy with the care provided. One relative told us, “The manager is very knowledgeable, professional and hands on.” Relatives felt the service and staff provided safe care. People received care from consistent staff members who knew and understood their care needs well. There were enough suitable staff to cover all the care calls. Staff understood their responsibilities for safeguarding adults.

People's care needs were assessed before they started to use the service. People were supported by staff who received a full induction to the service. Relatives felt staff were skilled and competent. Staff spoke highly of the support they received from the registered manager. A programme of supervisions and spot checks took place to ensure staff were well supported. People, relatives and staff were encouraged to offer feedback on the service and how it could be improved.

Procedures were in place to reduce the risk of infections and staff had regular access to personal protective equipment (PPE). Staff had received training on infection control and COVID-19 and had access to a range of infection control policies and procedures. People and relatives spoke highly of how staff had worked during the pandemic and managed the risks associated with COVID-19.

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.

Staff treated people with dignity and respect. Staff also understood the importance of promoting people’s independence. Relatives confirmed that their loved one’s privacy and dignity was always respected. Staff had received training in equality and diversity. Staff understood the importance of people’s faith and how it was important to them.

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 4 December 2019)

Why we inspected

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance

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.

Careessence provides personal care for people in their own homes. At the time of this inspection the service was providing personal care to three people, some of whom were receiving end of life care.

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

The provider checked candidates were suitable to care for people. There were enough staff to support people safely. The provider assessed risks to people and supported them in relation to these risks. People received their medicines safely. Staff followed suitable infection control practices and received training to understand their responsibilities.

Staff received training and support to care for people, including those at the end of their lives. People received the support they needed to maintain their day to day health and in relation to eating and drinking. 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.

Staff treated people with kindness, dignity and respect. People made their own decisions regarding their care. People received care from staff who knew them well and their care was personalised to meet their needs and preferences. Some people received social and emotional support from staff and this support was based on the individual. The provider told us they would provide information to people in alternative formats to meet people’s communication needs. The provider had a suitable process in place to respond to any concerns or complaints.

A registered manager was in post who was also a director of the company. Relatives and staff told us they thought the service was well-led and the provider engaged well with them. The provider had sufficient oversight of the service, working closely with people to check they were satisfied with their care and monitoring staff performance through spot checks and observations.

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 (report published October 2018).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

At our last inspection on 11 December 2017 we were unable to rate the service because there was insufficient evidence to do so. At this inspection we found similar concerns to our previous inspection and found there was enough evidence to rate the service Requires Improvement.

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. The registered manager was also the director of the service and had been in post since the service registered with us.

At this inspection we had sufficient evidence to rate the service Requires Improvement overall. The provider had not ensured people’s care records were stored and maintained securely and the only copy of a person’s care plan had gone missing. The provider lacked good oversight of the service as they had not identified the issues we found. These issues showed the registered manager lacked full understanding of their role and responsibilities.

As at our last inspection we found the provider had not always robustly checked staff had the right to work in the UK. When we raised our concerns, the provider carried out employer checks with the Home Office and sent us the required evidence.

The provider carried out other staff recruitment checks appropriately such as checks of any criminal records, work history, proof of identification and address, health conditions and references from former employers. There were enough staff deployed to support people safely.

The provider was no longer administering medicines so we did not look at medicines management at this inspection.

A person received care in line with the Mental Capacity Act 2005 and the registered manager had improved their understanding of the Act since our last inspection. Staff received training in the MCA.

Staff received training each year in key topics relevant to their role to help them understand their responsibilities.

The provider had systems in place to protect people from abuse and neglect and staff received annual training in safeguarding adults at risk.

The provider’s risk assessment processes remained suitable. The registered manager told us they had not had reason to review the person’s risk assessments since our last inspection but they would review them annually as standard or more often if required.

A person was involved in decisions regarding their care and received support with their day to day health. Staff were available to support people in relation to eating and drinking if this was part of the agreed package of care.

The provider had a complaints procedure to follow in investigating and responding to any complaints although they had not received any complaints.

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.

Although staff were recruited via procedures to check their suitability, the provider did not always check staff had the right to work in the UK. When we identified this the provider then obtained the necessary evidence confirming the right to work in the UK and told us they would ensure they carried out more robust checks during recruitment. There were enough staff deployed to support people safely.

The provider did not always record administration of a topical cream in line with best practice. This meant there were insufficient records of medicine administration to provide a robust audit trail. The provider told us they would improve this immediately. We have made a recommendation in relation to recording of topical medicines administration.

Although a person received care in line with the Mental Capacity Act 2005 the registered manager was unsure about how to follow the Act if a person did not have capacity in relation to their care. The registered manager told us they would improve their knowledge in relation to this by reviewing relevant literature.

The provider trained staff in key topics to help them understand their role and also supervised staff to further support them.

The provider had systems in place to protect people from abuse and neglect.

Risks relating to people’s care were reduced because the provider assessed and managed risks and put guidance in place for staff to follow. People’s care plans contained sufficient detail about people to be reliable to staff in caring for people.

People were involved in decisions regarding their care. People were supported to maintain their health and were supported in relation to eating and drinking by staff. Staff understood people’s needs and preferences.

The provider had a complaints procedure in place although they had not received any complaints.

A person and staff had confidence in the registered manager. However, we found the provider had not yet established systems to sufficiently audit the service and they had not identified the issues we found. We also identified some areas where the registered manager could improve the service and strengthen their knowledge.