Jeremys Carebuddies Limited

Jeremys Carebuddies Limited is a domiciliary care agency providing personal care and support to people living in their own homes. They are registered to provide care to all adults including those who may be living with dementia and have disabilities. The provider is also registered to provide the regulated activity of treatment of disease, disorder or injury. We did not inspect this regulated activity on this occasion.

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 our inspection they were offering personal care to 13 people.

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

Risks to people had been assessed by the provider and reviewed. Care workers had received medicines training and refresher training, and medicines administration was undertaken in an appropriate manner.

We found one of the three electronic records we looked at did not always contain information which was kept in paper files in people’s homes. There was a danger therefore office staff might not be fully aware of the guidance staff were following. This indicated electronic records had not always been robustly audited.

People and relatives spoke positively about their care workers and the care they received. Some relatives mentioned care workers sometimes ran a little late, but none felt this was a problem. People and relatives told us they thought the service was provided in a safe manner and found the registered manager was accessible and responsive to any concerns they raised.

Care workers had received infection control training and were provided with personal protective equipment (PPE) to protect themselves and the people they offered a service to from the risk of cross infection.

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 gave their written consent for their care and treatment and if someone acted on their behalf the provider checked their had a legal right to do so.

The registered manager assessed people prior to offering a service to determine their support needs and their preferences. The care plans were person centred and contained guidance for staff about how people wanted their care provided.

The registered manager had recruited a new care co-ordinator to support with the management of the agency. They had improved communication systems with people and staff.

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)

We carried out an announced comprehensive inspection of this service (published 25 September 2019) and breaches of legal requirements were found. There were breaches of regulation 9 (Person centred care), regulation 11 (Need for consent) and regulation 17 (Good governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found they were no longer in breach of the regulations 9, 11 and 17. We found whilst the provider was no longer in breach of the regulations they were still rated as requires improvement in the well- led key question. This was because the provider did not work in partnership with the CQC and did not always facilitate inspection visits. In addition, although much improved since the last inspection they had not identified through checks and audits an electronic care plan was not updated in line with the person’s current moving and handling requirements in a timely manner.

Why we inspected

This was a planned inspection to check the provider had completed actions to address the breaches identified at our previous inspection of July and August 2019.

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.

The last rating for this service was requires improvement and we found improvement had been made and they were no longer in breach of the regulations and the service has improved to a rating of good overall.

Follow up

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

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 not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Although all the people who used the service had the capacity to make decisions, these were not always respected. None of the care plans were signed by people and there were no consent forms in place to evidence people had been consulted.

Where specific risks were identified, support plans were not always personalised and there were no guidelines from healthcare professionals to help staff meet people’s individual needs. Risk assessments were in place but were not always rated according to the level of risk.

People's needs were assessed before they started using the service and care plans were developed from initial assessments. However, instructions on people’s care plans were confusing and there was a risk staff would not know how to meet people’s individual needs.

Although improvements had been made in relation to the management of medicines and staff recruitment, the provider’s systems for monitoring the quality of the service had failed to identify the shortfalls we found during our inspection.

People who used the service and their relatives were happy with the service they received. People said that the staff were kind, caring and respectful and they had developed good relationships with them.

The provider worked with other professionals to make sure people had access to health care services. People received their medicines safely and as prescribed. People’s nutritional needs were assessed and met.

Staff were happy and felt well supported. They enjoyed their work and spoke positively about the people they cared for. They received the training, support and information they needed to provide effective care. The provider had robust procedures for recruiting and inducting staff to help ensure only suitable staff were employed.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 25 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 25 July 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jeremys Carebuddies Limited on our website at www.cqc.org.uk.

We have identified breaches in relation to consent, person-centred care and good governance at this inspection.

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.

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

We have made a recommendation about risk assessment.

Follow up

We will request an action plan for 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.

Jeremys Carebuddies Limited provides a domiciliary care service for older people living in their own homes in the community. The service offers support to people who require help with day to day care including personal care and meal preparation. They also offer a live-in care service. At the time of our inspection all of the nine people using the service were receiving personal care.

The service is registered to provide the regulated activities personal care and treatment, disease, disorder and injury (TDDI). The registered manager confirmed they were not providing the regulated activity TDDI to any people at the time of our inspection.

The service is required to have a registered manager and there was one in post who was also the owner of the service. 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.

Information about people’s medicines was not always recorded. Medicines administration records did not give accurate details about people's medicines or whether these had been administered as prescribed, although the people using the service and their relatives who spoke with us, told us they had been administered.

Staff recruitment procedures were not always followed to ensure only suitable staff were employed by the service.

People’s needs had not always been assessed prior to receiving care so their needs and wishes could be identified and recorded. If someone’s care needs had changed, the care plans had not always been updated to reflect this.

The registered manager was frequently working as a care worker in people’s homes and therefore her time to effectively manage the office and the operation was restricted. They did not have the time to audit and monitor the quality and safety of services people received and had not identified shortfalls within the service.

People and relatives said they felt people were being cared for safely. Policies and procedures for safeguarding people from the risk of abuse were in place and staff understood these and knew to report any concerns. Risk assessments for risks to people and for their home environment were carried out. People were protected from the risk of infection as staff understood infection control procedures and followed them.

Staff received the training they required to provide them with the knowledge and skills to care for people effectively. Staff assisted people with meal preparation where required. If staff had any concerns about a person’s health they knew the processes to obtain help and advice for the individual.

The registered manager said that people using the service were able to make decisions for themselves and staff respected this. Staff understood people should make their own decisions about their care and treatment and knew to report any deterioration in a person’s ability to do so.

People and relatives said staff were caring and treated people with dignity and respect. Staff understood people’s right to make choices about their lives and respected this.

The majority of care plans viewed provided a clear picture of the person and the care and support they required. Background information about people’s lives provided staff with topics of interest to talk about. There was a complaints procedure in place and people and relatives confirmed they would feel confident to raise any concerns with the registered manager.

People and relatives said they were happy with the service and that the registered manager and staff understood how to meet people’s needs. Staff said they were happy working for the service and felt supported by the registered manager. Policies and procedures were in place and reflected current good practice guidance and legislation.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person-centred care, safe care and treatment, fit and proper persons employed and good governance. You can see what action we told the provider to take at the back of the full version of the report.