PHC Home Care Limited

PHC Home Care Limited is a small domiciliary care agency providing personal care to nine people living in their own home or flat. The agency is based in Harrow North West London.

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

People could not always be confident that they received their medicines as prescribed. Risk assessments and management plan identified risks related to the care provided and gave guidance for care workers to minimise such risks. The service had introduced new quality audit tools, however, we found these were not always effective.

The service had made improvements in ensuring that care calls were not missed, and care workers stayed the allocated time with people who use the service. The service had clear systems to keep people safe and safeguarded from abuse. Care workers had received training in safeguarding adults at risk. Safe recruitment procedures were in place. This ensured all pre-employment requirements were completed before new staff were appointed and commenced their employment.

People's needs had been assessed by the service, the service was meeting people’s needs and since our last inspection people had received their care calls as documented in their care plans. People’s health care needs were monitored, and action was taken if their healthcare needs had changed. Care workers received training before commencing their care duties and ongoing support was provided through one to one supervisions and annual appraisals. People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People felt the service they received helped them to maintain their independence where possible. People received care that was planned with them and their relatives to meet their individual needs and preferences, from care workers who were caring and respected their privacy and dignity.

People were involved in their care and were encouraged to share their views and preferences. People had personalised care plans which were regularly reviewed. People and relatives were happy with the care workers that supported them. People were able to voice their concerns and were confident that any issues would be addressed and dealt with by the agency.

The registered manager promoted person centred care to improve people's quality of life that was reflected throughout the service. The registered manager understood the duty of candour and promoted an open and honest environment. Care workers were clear about their roles and had good management support throughout the service. People who used the service, relatives and staff were encouraged to provide feedback regarding the service and an open-door policy was promoted.

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 requires improvement (published 7 March 2019). The service remains rated requires improvement. This service has been rated twice inadequate and twice requires improvement for the last four consecutive inspections.

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.

At our previous inspection in April 2018 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to risk assessments, staff training, care plans and quality monitoring. The provider was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During our comprehensive inspection in April 2018, the service demonstrated to us that improvements had been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service has a registered manager. 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.

We found that risk assessments were now in place for a range of identified risks including moving and handling, skin care, eating and drinking, medicines and environmental safety. These provided information for care workers on actions to be taken to reduce the risk of harm.

The service now had sufficient numbers of care workers to be deployed to meet people’s needs. However, a few people still reported late or missed calls. Care workers confirmed to us that they were undertaking all calls as assigned. We looked at staffing rotas which the registered manager told us were provided to care workers on a weekly basis. These showed that people were supported by the same care workers wherever possible.

Improvements had been made in safeguarding people. There was a safeguarding policy and procedure in place. Care workers could tell us about signs of abuse, including relevant reporting procedures, such as reporting concerns to their manager, the local authority or Care Quality Commission (CQC).

Safe recruitment procedures were now in place. This ensured all pre-employment requirements were completed before new staff were appointed and commenced their employment. At least two references were in place for all care workers. A Disclosure and Barring Service (DBS) check had been completed prior to staff commencing work.

The system for monitoring calls had not been developed further since our last inspection. We found that the registered manager continued not to have oversight of missed calls. We found the monitoring system to be ineffective as no late or missed calls had been recorded even though we had been notified by people of recent occurrences.

People's needs had been assessed by the service prior to receiving services. Care plans included guidance about meeting these needs. However, some people had missed calls, which meant they may not have received care that met their needs.

The service monitored people’s health and when it was necessary health care professionals, like doctors and district nurses were involved to make sure people were supported to remain as healthy as possible. However, in some examples we found that people who had significant weight variations had not been referred to specialists.

Staff had now completed essential training. Future training and refresher courses had been scheduled for 2019. New care workers had completed an induction using the Care Certificate framework before commencing work. They had received supervision, which included one-to-one meetings and work based observations (spot checks).

The requirements of the Mental Capacity Act (MCA) 2005 were met. People were involved in making decisions about their care and support. People had signed their plans to show that they consented to the care provided by the service.

The feedback we received from people concerning care workers was mostly positive. However, the concerns we found at this inspection did not demonstrate a caring approach. Some people still reported late calls and these were not recorded or analysed, which meant there was not system for ensuring improvements were carried out.

People’s care plans were now detailed and gave an account of people’s needs and actions required to support them. The care plans we reviewed were up to date and contained information about the support that people required. However, we found a record of an incident that demonstrated that a care worker may not have followed care plan guidance while delivering care.

Since our last inspection in April 2018, the registered manager had introduced systems and processes to improve on their governance systems. However, the service could not demonstrate significant improvements. The service still did not maintain accurate, complete and contemporaneous records relating to care delivery. The system for recording complaints or issues was also ineffective. No complaints had been recorded at the service, even though people and their relatives had spoken about concerns.

The provider has still not taken all reasonable steps to ensure that they are financial viable to continue to support people.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and a breach under Regulation 13(1) of the Care Quality Commission (Registration) Regulations 2009 (the 2009 Regulations). You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At our previous inspection in January 2018 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to risk assessments, staff training, care plans and quality monitoring. During this inspection we found that some improvements had been made in relation to these breaches. However, we identified further failures to meet the regulations.

The service has a registered manager. 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.

Prior to this inspection CQC had received intelligence from external sources, including professionals, raising concerns for the safety of the people receiving care from PHC Home Care Limited. We considered these concerns as part of our inspection.

The leadership and management of the service was inadequate and placed people at risk of harm.

Risks to people had not always been identified and managed appropriately. We found that care workers did not always have the information they needed to deliver safe care and treatment to people. Although we found that some care plans had been updated since our last inspection, there remained a failure to ensure that these reflected potential risks identified elsewhere in people’s care documents.

The service did not have sufficient numbers of care workers to meet people’s needs. People had consistently received late or missed calls. Chances for improvements were limited because the service did not learn and make improvements when things went wrong. Similar incidents had continued to occur because the service did not monitor calls on a routine basis to make sure they were completed.

The service did not have clear systems to keep people safe and safeguarded from abuse. At our last inspection of the service we found that there was no evidence that new care workers had received training in safeguarding of adults at risk. At this inspection the training records showed that these staff members had still not received up-to-date safeguarding and safety training appropriate to their role. Furthermore, care workers with previous cautions or convictions had continued to work with people even though risk assessments had not been completed.

The provider did not show us that they had enough money to keep the service going.

There was no evidence of learning, reflective practice and service improvement. Whilst there was an internal audit system in place, we found this to be unreliable and irrelevant because shortfalls were either not addressed or identified. This meant we could not be assured that the audit process was effective.

At our previous inspection the provider was unable to demonstrate that care workers had always received the training and support that they required to ensure that they were competent in their roles. This had remained the case at this inspection.

Even though people told us care workers were caring, the concerns we found at this inspection did not demonstrate a caring approach. The provider was unable to demonstrate that new care workers had always received the training and support that they required to ensure that they were competent in their roles. This meant they may not have been sensitive to the needs of people.

At the last inspection we found that people’s individual care needs assessments did not always include information about their personal needs and histories. Information contained in the assessments that was relevant to people’s care was not always included in their care plans.

At the last inspection we found that the system of responding to complaints was not operating effectively. This continued to be the case at this inspection. People told us they had raised concerns regarding late or missed visits and these had not been addressed satisfactorily. We saw no evidence that concerns were dealt with appropriately and any learning implemented to improve the service. This was also true of complaints from care workers, which we saw had not been addressed by the service. This meant we could not be sure people's and staff’s views were considered or that complaints were acted on in line with the service’s policies.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the inspection we met with the provider on 11 May 2018 asking what action they had taken to address the concerns raised. Following the meeting they provided us with information and evidence of the action taken to address some of the concerns raised. However, we were not reassured the provider will be able to meet its financial commitments and therefore to provide care to people. We were not assured that the issue relating to staff shortages would be resolved. We took this information into account when deciding what action we took. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for the service from this inspection is 'Inadequate' and therefore the service is continuing 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, it 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 there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action 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

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

At our previous inspection of 13 & 15 July 2017 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to risk assessments, staff supervision, care plans and quality monitoring. During this inspection we found that some improvements had been made in relation to these breaches. However we identified further failures to meet the regulations.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults living in the London borough of Harrow.

The service has a registered manager. 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.

Most of the people and staff members that we spoke with were positive about the service. A family member said that there had been problems with staff missing calls but they were satisfied that this was now resolved. Another person told us that they did not always have the same staff and were not informed about any new staff members visiting them. A staff member said that they did not always know who they were visiting until the morning of their shift. In addition, r we were informed by a commissioning local authority that there had been a number of missed calls during the month prior to our inspection and that there had been a complaint about care provision. .

At our previous inspection of the service we found that the provider had failed to develop care plans and risk assessments for some people. During this inspection we saw that risk assessments and care plans were now in place. However, these did not always provide information in relation to care needs and risks that we found in other documents contained within people’s files. The provider had updated people’s assessments of needs, but these did not now include some information in relation to people’s personal needs and histories. This meant that we could not be sure that staff members had the information they required to always provide safe care.

The records in relation to the administration of people’s medicines were not clear and there was no record that these had been monitored by a manager. Where staff had recorded that they had ‘prompted’ a person to take their medicines in the care notes, there was no medicines administration record in place.

When we looked at records relating to staff recruitment we found that some staff were working at the service without evidence that background checks such as references and criminal records (DBS) checks had taken place. Where staff had criminal convictions on their DBS the provider had not assessed the likely risk of employing them to work in a care role. We also found that there was no evidence that formal training had taken place for staff who had been working at the service since October 2017. The provider had failed to ensure that they were recruiting and training new staff in a manner that ensured that they were safe and suitable for their roles as carers.

At our previous inspection of this service we found that the provider had failed to ensure that staff members received support through regular supervision by a manager. During this visit we noted that staff members had each received a recorded supervision session.

The provider had a complaints procedure. However, when we looked at the records of complaints received we were unable to identify if these had been fully and properly investigated. We could not be sure that the service effectively handled complaints.

At our previous inspection of the service we found that the provider did not have effective systems in place to monitor the quality of the service. During this inspection we looked at the available quality assurance monitoring records and found that these remained ineffective. Satisfaction surveys of people and staff had taken place and these showed high levels of satisfaction. However, where other monitoring had taken place there was little or no detail of any issues that had been identified or of actions taken to address these. We noted that the provider had identified that reference and criminal records checks “need to be more robust” in August 2017. However they had failed to address this at the time of this inspection. There was no evidence that care and medicines administration records had been audited or that other failures identified during this inspection had been identified.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the inspection we contacted the provider asking what action they had taken to address the concerns raised. They provided us with information and evidence of the

action taken to address some of the concerns raised which showed some of the risks identified at time of inspection had been lowered. . We took this information into account when deciding what action we took.. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for the service from this inspection is 'Inadequate' and the service will enter '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, it 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 there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action 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

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

PHC Home Care Limited is a domiciliary care agency that provides a range of supports to adults living in their own homes. At the time of our inspection the service provided care and support to 54 people.

PHC Home Care Limited was formerly known as Pinner Home Care. The service was re-registered with The Care Quality Commission on 14 August 2015 due to a change name and legal entity. This was their first inspection under their new registration.

The service had a registered manager. 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 who used the service spoke positively about the care that was provided to them. Staff members also spoke positively about the people who they supported.

People were protected from the risk of abuse. The provider had taken reasonable steps to identify potential areas of concern and prevent abuse from happening. Staff members demonstrated that they understood how to safeguard the people whom they were supporting. Safeguarding training was provided to staff.

We looked at how the service managed risk to people. Detailed risk assessments containing guidance for staff on how to manage risks were in place for people receiving long term care and support. The service also supported people receiving short term support for a period of up to six weeks following a hospital stay. We found that the service had not developed risk assessments for these people. This meant that we could not be sure that risks to people were always managed safely.

The service had developed care plans for people receiving long term care and support. These contained information for staff on how they should ensure that care was provided to people according to their needs and wishes. However, the service had not developed similar care plans for people receiving short term support. The information that we saw in their care files did not include details of care activities that staff told us that they were providing.

Arrangements were in place to ensure that people’s medicines were given and recorded. Staff members had received training in safe administration of medicines.

The service had ensured that recruitment processes were in place to ensure that workers employed by the service were suitable. We saw that checks regarding the suitability of staff members had taken place before they commenced working with people.

The staffing rotas maintained by the service showed that people’s support needs were met. People who told us that there had been problems with late or missed calls in the past confirmed that this was not currently a concern. There was a system for ensuring that care calls were managed and monitored. Staff and people who used the service had access to management support outside of office hours.

Staff training met national standards for staff working in social care organisations and staff members spoke positively about the training that they had received. However we found that some staff members had not received regular supervision from a manager to ensure that they received the support that they required to carry out their roles and responsibilities.

The service was meeting the requirements of the Mental Capacity Act. Care documents included information about people’s capacity to make decisions. People were asked for their consent to any care or support that was provided.

People’s religious, cultural and other needs and preferences were supported. The service had matched people with staff members who spoke their preferred language where this was not English. People told us that staff members respected their wishes and treated them with dignity and respect.

People who used the service knew what to do if they had a concern or complaint. Complaints that had been received by the service had been investigated.

People who used the service and staff members spoke positively about its management. Some processes were in place to monitor the quality of the service, such as satisfaction surveys and spot checks of care practice. However we found that records of other quality assurance processes were limited.

We found four 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 the report.