Background to this inspection
Updated
20 May 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
The inspection took place shortly before the government introduced restrictions on movement to control the spread of coronavirus. This report presents our findings at the time of the inspection, but there may have been significant changes since this time.
Inspection team
The inspection was carried out by four inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the inspection
We reviewed information we held about the service. This included our previous inspection findings and records of notifications of serious events the provider is required to send us. We had maintained contact with officers from the local authority and spoke to one contracts manager before the inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
Inspection site activity started on 11 March and concluded on 13 March 2020. We spoke to the registered manager, regional director, director of quality and care and three care co-ordinators. We reviewed records of care and support for 20 people. We reviewed records of recruitment, training and supervision for 11 care workers. We examined weekly rotas for 11 care workers.
Between 16-18 March we contacted people who used the service and their relatives. We attempted contact with 57 people and spoke with 17 people who used the service and 23 of their relatives.
After the inspection
We spoke to the provider to obtain further clarification about our findings. We made calls to seven care workers.
Updated
20 May 2020
About the service
This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection the service was providing personal care to 249 people.
People’s experience of using this service
The provider had greatly improved systems to monitor the service and this had resulted in significant improvements.
The service offered support and advice to staff and worked to ensure availability of personal protective equipment in response to the outbreak of COVID 19. There were suitable business continuity plans to continue to deliver a service should staffing be further affected by the crisis.
People were safeguarded from abuse and ill treatment. Staff received training in safeguarding adults and were confident in reporting concerns. The provider had effective systems for assessing risks to people’s safety and wellbeing. This included improved approaches to compiling moving and handling plans. There had been an improvement in punctuality, but people told us they still frequently experienced late visits. Staff did not always have enough time on their rota to travel to calls, which the provider had started to address. People received their medicines safely and there was improved management and audit of this.
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. The provider carried out detailed assessments of people’s needs before they started to receive care. People received the right support to eat and drink. People’s health conditions were assessed and there was improved reporting of concerns when people appeared unwell. Staff received appropriate training and support to carry out their roles and managers checked that staff had the right skills and approach to support people effectively.
People told us they were treated with dignity and respect. Care plans contained improved information on people’s preferences for their care and more detailed information about people’s life stories and what was important to them. Staff understood how to communicate with people well and offer choices.
People’s care was planned to meet their needs. The service checked care was being delivered as planned and regularly reviewed people’s care plans. People knew how to complain and there was an improved response to complaints.
Managers engaged with people to find out their views on the service. There were more rigorous and advanced systems of audit and these were used together with learning from incidents to deliver a credible plan to continue to improve the service. Staff received appropriate support from managers who engaged well with care workers to keep them updated. People told us they had struggled to contact the office, and the registered manager had made changes to office roles and the training of supervisors as a result. The provider worked with the local authority and other agencies to continue to develop and improve 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 22 March 2019).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We did not find any breaches of regulations at this inspection. 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.
We will continue to work with the provider to offer support and monitor measures taken to protect people from the outbreak of coronavirus.