ELR Homecare Ltd

ELR Homecare Ltd is a domiciliary care service providing care and support to people in their own homes. At the time of the inspection 51 people were using the service.

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 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 interest; the policies and systems in the service supported this practice.

There were enough staff to meet people's needs and the correct recruitment procedures were followed to ensure staff were suitable to work with people in their own homes.

People's medicines were administered and managed safely by trained and competent staff, and people received them as prescribed. Lessons were learnt, and the service had improved when things went wrong.

The provider assessed people's needs and worked in line with current good practice. Staff were trained and supported to ensure they delivered effective care and support to people. People receive consistent and timely care which met their needs and circumstances.

Please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was inadequate (report published 9 December 2021) and it was placed in special measures. At this inspection we found the provider had made improvements. As the service is no longer rated as inadequate in any of the five key questions, it is no longer in special measures.

Why we inspected

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

Follow-up

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

ELR Homecare Ltd is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 78 people, at the time of our inspection.

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

The systems the provider had implemented did not provide them with adequate oversight, which meant risks to people’s safety had not been identified and responded to appropriately. Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm. The lack of effective systems in place had failed to identify the areas for improvement found at this inspection including the care planning, risk assessments, training, safe recruitment processes and safe administration of medication.

Care plans were not in place for known health conditions to enable staff to have the information they needed to mitigate risk and meet or respond to people’s needs.

People were supported by a staff team who told us they understood how to protect them from abuse. Staff also understood how to protect people from harm and how to report concerns. However, the provider had failed to ensure all staff members had received up to date training. This placed people at risk from potential abuse and harm or injury.

People we spoke with said they felt safe and were very happy with the support they received.

Care plans did not always include the same medications listed on the medication administration records (MAR) for people using the service. This meant care staff had conflicting records to refer to, which could lead to errors occurring. Prescribed creams recorded on MAR records did not always have clear instructions to inform care staff where to apply creams.

Staff were not always recruited safely. Safe recruitment practices were not followed and this placed people at risk of harm due suitable references not always being obtained and gaps in employment not being explored.

Audits needed to be more robust to provide clear information and evidence of outcomes and actions for people using the service.

Systems and process which were in place were not robust to protect people from potential harm.

Staff we spoke to told us they understood their roles and responsibilities and on the whole felt supported by the management.

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 of this service was requires improvement (published 28 August 2019) and we found breaches of regulations. The provider was required to complete an action plan after the last inspection to show what they would do and by when to improve. We found that the provider had not made enough improvement in their oversight and management of the service and remained in breach of Regulation 12 Safe care and treatment and Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. During this inspection we found new breaches of Regulation18 Staffing and Regulation 19 Fit and proper persons employed.

At this inspection the overall rating for this service is ‘Inadequate’ and the service therefore is 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. We found that the provider had not made enough improvement in their oversight and management of the service and remained in breach of Regulation 12 Safe care and treatment and Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. During this inspection we found new breaches of Regulation 18 and Regulation 19.

This service was rated as good following the inspection (published 10 May 2017).

Why we inspected

This was a five key question responsive inspection based on CQC receiving concerns and complaints. Prior to the inspection CQC received concerns about lack of COVID testing for staff, lack of leadership and safeguarding concerns. The information shared with CQC indicated potential concerns about how people were being supported and risks being managed. As a result of these concerns we looked at how the provider was managing risks, protecting people from potential harm, recruitment processes, training and management of the service.

Enforcement

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report to see what actions we have asked the provider to take.

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.

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 we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, good governance, staffing and fit and proper persons employed.

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

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

ELR Homecare Ltd is a local area domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection the service supported 19 people.

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

People’s needs and wishes were not assessed by the provider prior their joining the service. This meant the systems in place to manage risks associated with people's care needs did not always provide staff with information to manage those risks. In addition, staff were not consistent in their recording and monitoring of some people's needs. There were changes in people's physical and emotional wellbeing not being identified.

The provider’s governance systems to check the quality of the service provided for people were not consistently effective and required improvement.

People and relatives told us they felt the service was safe. There had been issues with staffing that had led to some late and missed calls; although we were told this had improved with the recruitment of new staff members. Staff told us they received the training they required to meet people’s needs. Staff told us they had completed their induction training which included safeguarding, medication, health and safety and moving and handling. Staff had access to equipment and clothing that protected people from cross infection and followed safe infection control practices.

Where staff supported people with their medicines, records showed there were no areas of concern. People were supported to access health care professionals when they needed them. The provider worked with other agencies to provide joined up care.

People were supported to have maximum choice and control of their day-to-day care 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 by kind and caring staff. Staff encouraged people’s independence, protected their privacy and treated them with dignity.

People were supported by staff who knew their preferences. Complaints made since the last inspection had been investigated, however improvements were needed to ensure monitoring of complaints identified any trends and lessons learnt. People and their families knew who to contact if they had any complaints.

There were mixed views from people and their relatives regarding the way the service was managed by the provider. People and their relatives’ views were sought about the quality of the care being provided. Overall, staff felt supported by the management team.

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 10 May 2017).

Why we inspected

This was a planned inspection based on the previous rating. However, we had brought it forward prompted in part in response to information CQC received about missed and late calls, lack of training for staff and the general management of the service. This inspection examined those risks. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

In response to the issues found at this inspection, the provider has already implemented changes to address our concerns and mitigate the risk of harm to people using the service.

Enforcement

At this inspection we have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities 2014) around safe care and treatment and governance. Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

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.

There was a registered manager at this service, who was also the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 were satisfied with the reliability of staff, and with the consistency in the carers who supported them. Individual risk assessments were in place to provide guidance to staff as to how to care for people safely. Staff understood how to recognise and report harm or abuse. Where staff had raised concerns with the registered manager, action had been taken.

People received their medicines safely, and as prescribed. People were supported by staff who had undergone pre-employment checks to ensure they were suitable to work in care.

People received care in a manner which was in accordance with the principles of the Mental Capacity Act. Staff received ongoing training and development, which was relevant to the needs of the people they cared for and enhanced their practice. People were supported with their eating and drinking needs. Where there were concerns about people's health or wellbeing, referrals were made to healthcare professionals and their guidance and recommendations were followed.

People enjoyed respectful and positive relationships with their carers. People's dignity was maintained. People's individual communications styles and preferences were known by staff, and staff tailored their approach to meet individuals' needs.

People's changing health needs and wellbeing were responded to. reviews of people's care took place to ensure that people's needs continued to be met. Staff respected people's preferences and how they wanted to be cared for.

Where people or relatives were dissatisfied with the care provided, they knew how to make a complaint. Complaints and feedback were acted upon.

People and relatives were pleased with how the service was run and how their views and feedback were listened to. People, relatives, staff and health professionals found the registered manager to be approachable and quick to take action, as required.

Systems were in place to monitor the quality of care provided. Where shortfalls were identified, these were acted on to make improvements to the care provided.