Archived: Rapid Improvement Care Agency

Rapid Improvement Care Agency is a domiciliary care agency. It provides personal care and reablement service to people living in their own houses and flats. It provides a service to older adults. At the time of this inspection 14 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is to 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 received care and support which was safe and personalised to their needs. Staff understood their responsibility to protect people from the risk of abuse and to report any concerns to the office. Risks to people had been identified, assessed and managed well. People were supported to take their medicines safely and there were enough staff available to support people. Staff followed appropriate infection control procedures to minimise the spread of infections.

Before people started using the service, their needs were assessed to ensure they could be met. People received care and support from staff who had been supported through induction, training, supervision and appraisals. People were supported to maintain good health; eat healthily and access healthcare services when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's communication needs had been assessed and met and they were involved in making decisions about their care and support. People knew how to make a complaint if they were unhappy.

People were complimentary about the service and told us it was well led. The service had effective systems in place to assess and monitor the quality and safety of the service. The service worked in partnership with key organisations to plan and deliver an effective service. People and their relatives' views were sought to improve on the quality of care and support provided.

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 23 April 2020). 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, receiving and acting on complaints, good governance and staffing.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an announced comprehensive inspection of this service on 27 February 2020. Breaches of legal requirements were found. 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 Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement 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 Rapid Improvement Care Agency on our website at www.cqc.org.uk.

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.

Rapid Improvement Care Agency is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. At the time of this inspection 40 people were using the service.

People’s experience of using this service

Specific risk to people had been identified but risk management plans did not always include detailed guidance for staff on how risks could be managed safely. People were not always supported with their medicines safely. People were not always supported at the time and duration planned for their visits. Where people had made verbal complaints, these were not always handled to their satisfaction. People’s care records and staff files were not always complete. The systems in place to assess and monitor the quality of the service were not always effective in driving improvement and did not identify the shortfalls we found at our inspection.

Care and support was planned but it was not always delivered to people’s satisfaction. The service worked in partnership with key organisations including the local authority that commissioned them. However, feedback we received from professionals was not always positive.

We have made two recommendations in relation to staff support and meeting people’s nutritional needs.

People were protected from infectious diseases because staff followed appropriate infection control protocols. Staff understood their responsibility to protect people from the risk of abuse. Before people started using the service, their needs were assessed to ensure they could be met. Where required, people were supported to assess healthcare services. 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 by staff that were kind, caring and respectful toward them. People and their relatives were involved in planning their care and support plans. People’s privacy and dignity was were respected, and their independence promoted. People’s diverse needs were respected, and people were not discriminated against in any way. People’s communication needs had been assessed and met. People, their relatives and staff views were sought to improve on the quality of 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:

The last rating for this service was requires improvement (published 18 March 2019). This is the third time the service was rated requires improvement.

Why we inspected

We carried out an announced comprehensive inspection of this service on 6 and 7 February 2019. 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, person-centred care, dignity and respect, safe care and treatment and good governance.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

Enforcement

We have identified breaches in relation to risk management, staffing, medicines management, complaints and systems in place for managing the quality and safety of the service at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

People’s experience of using this service:

¿ People were put at risk of receiving unsafe care and support because staff did not always arrive on time and the systems in place were not always effective in driving improvement.

¿ People received care and support that was personalised to their needs.

¿ Risks to people had been identified, assessed and they had management plans in place to reduce the risk occurring.

¿ People’s medicines were managed safely.

¿ People were protected from infectious diseases because staff followed appropriate infection control protocols.

¿ There were enough staff available to support people’s needs.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ Staff had the knowledge and experience to support people's needs. They were supported through induction, training and supervision to ensure they carried out their roles effectively.

¿ People were supported to maintain good health and they had access to healthcare services where this was required.

¿ People’s privacy and dignity was respected and their independence was promoted.

¿ People were involved in making decisions about their care needs.

¿ People and their relatives knew how to make a complaint if they were not happy with the service.

¿ No one using the service required end of life care and support; however, there were systems in place to ensure that people had access to end of life care when required.

¿ Feedback from people, their relatives and staff was being used to develop the service.

¿ The provider worked with key organisations to plan and deliver joined-up care.

¿ Staff said they enjoyed working at the service and felt supported in their role.

Rating at last inspection: Requires Improvement. (Report published 3 March 2018) This is therefore the second time the service has been rated as Requires Improvement.

Why we inspected: This inspection was part of a scheduled plan based on our last rating of the service and aimed to follow up on some concerns we had found at our inspection in January 2018.

Enforcement: Action we told provider to take (refer to end of full report)

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.

The service had a registered manager in post. 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 systems in place to check the quality of care and service provided did not always identify issues. We found that staff did not ensure that best practice guidelines were followed in line with the Mental Capacity 2005 (MCA) in connection to the decision made about one person’s care and support. The registered manager however took immediate steps to address our concerns. Staff had received training in the Mental Capacity Act 2005.

People’s care needs and risks to their health, well-being and safety were assessed and care plans developed on how identified needs would be met. Staff had training to do the job. Staff were supported through regular supervision, appraisal, spot checks and direct observation to be effective in their roles. Staff supported people with their nutritional needs.

The service had policies and procedures in place to protect people from the risk of abuse. Staff were trained in safeguarding adults from abuse and they knew what actions to take if they suspected abuse had occurred. People received care visits from staff to meet their needs. Staff recruited to work with people were thoroughly vetted to ensure they were suitable for their roles.

People were supported to manage their medicines safely. Staff were trained and followed good infection control procedures. The service had a system for reporting incidents and these were reviewed by the registered manager.

People had access to healthcare services they needed to maintain their health and staff supported them to attend their appointments. The service ensured people received the care they needed when the moved between services.

People and their relatives told us that staff were kind and caring towards them. Staff involved people in day to day decisions about their care. Staff respected people’s dignity and privacy. People were encouraged to maintain their independence as much as possible. Staff knew how to support people with their needs.

The service planned people’s care and support to meet their individual needs and requirements. The service supported people to maintain their religious beliefs and culture. Staff understood how to provide care to someone at the end of their life.

People and their relatives knew how to complain if they were unhappy about the service. People were asked for their views about the service. These were used to improve the service.

The service worked in partnership with other organisations to improve the service. They had an annual business improvement plan on how they would develop, sustain and improve the service.