Archived: My Homecare Reading

My Homecare Reading is a domiciliary care agency that provides personal care to people in their own homes. It provides a service to people who have dementia, learning disabilities or autistic spectrum disorder, mental health, physical disability and older people.

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 the service was providing personal care to eight people.

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

The provider did not operate effective quality assurance systems to oversee the service. These systems did not identify shortfalls in the quality and safety of the service or ensure that expected standards were met.

The provider did not ensure consistent actions were taken to reduce risks to people and plans were not in place to minimise those risks. Effective recruitment processes were not in place to ensure, as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines was not always safe. Staff did not always follow correct infection prevention and control processes when visiting people. Not all staff were up to date with, or had received, their competency checks and mandatory training. We did not have evidence the management team kept their knowledge and competencies checked and up to date. Staff did not have regular supervision and appraisals, and team meetings.

When incidents or accidents happened, it was not always clear that it was fully investigated, and if any lessons were learnt. The provider did not follow and accurately record and keep a copy of all the actions taken as required in the duty of candour regulation when a notifiable safety incident occurred. The registered person did not ensure that clear and consistent records were kept for people who use the service and the service management. The registered person did not inform us about notifiable incidents in a timely manner. Staffing levels did not always support people to stay safe and well. The provider scheduled the visits however timings and length of visits varied. People and relatives told us the times of visits were not kept according to the care plan. People and relatives gave us mixed feedback about staff being kind, caring and respectful. They did not always uphold people's privacy or respond in a way that maintained people's dignity.

People, their families and other people that mattered were involved in the planning of their care. However, the care plans did not contain information specific to people’s needs and how to manage any conditions they had. Staff did not have detailed guidance for them to follow when supporting people with complex needs. Staff were not always following the care plan to provide the right support to people.

The provider did not ensure their safeguarding systems were operated effectively to investigate and follow the provider's procedure after becoming aware of an allegation of abuse. Most of the staff were not up to date with their safeguarding training. Not all people and relatives felt they could approach the management or staff with any concerns and felt that communication had to be improved.

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

Most of the staff members felt staffing levels were sufficient to do their job safely and effectively. The provider appreciated staff contributions and efforts during the COVID-19 pandemic to ensure people received the care and support. Staff felt they could approach the management team for support and advice. The provider was working with the local authority to make improvements.

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 15 August 2018).

Why we inspected

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

Enforcement and Recommendations

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 will take further action if needed.

We have identified breaches in relation to quality assurance; risk management; notification of incidents; safeguarding; record keeping; effective and person-centred care planning; management of medicine; infection control and prevention; staff training, competence and deployment, and recruitment. Please see the action we have told the provider to take at the end of this report.

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 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 alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.

My Homecare Reading is a domiciliary care agency that provides personal care to people in their own homes. It provides a service to people who have dementia, learning disabilities or autistic spectrum disorder, mental health, physical disability and older people.

The Care Quality Commission (CQC) only inspects the service being received by people provided with the regulated activity ‘personal care’; help with tasks related to personal hygiene and eating. Not everyone using the service receives the regulated activity. Where they do we also take into account any wider social care provided. At the time of our inspection the service was providing personal care to 18 people.

The service had a registered manager in place. 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 registered manager assisted us during the inspection.

People felt safe while supported by the staff. Relatives agreed the staff supported their family members and made them feel reassured. The registered manager and the staff had a good understanding of how to keep people safe and their responsibilities for reporting and recording accidents, incidents or concerns.

People felt they were not always treated with respect, but their privacy and dignity were promoted most of the time. People and relatives felt the staff supported them in the way they wanted however some staff’s skills could be improved like time keeping, being friendly and kind, and hand washing.

People were supported by sufficient numbers of staff to meet their individual needs. Where possible, the registered manager scheduled visits so the same staff went to see people to maintain continuity of care and support. People were informed about the changes to their visits most of the time. The service completed an appropriate recruitment procedure before new staff were employed to work with people. They checked to ensure staff were of good character and suitable for their role.

Staff training records indicated which training was considered mandatory. The registered manager and senior staff had planned and booked training when necessary to ensure all staff had the appropriate knowledge to support people. Records showed staff received ongoing support via regular supervision and appraisals. Staff felt supported by the management team and were motivated to maintain good team work.

People's rights to make their own decisions, where possible, were protected and respected. The registered manager was aware of their responsibilities to ensure people's rights were promoted and they encouraged this within the staff team practice. Staff were aware of their responsibilities to ensure people's rights were promoted and support to make decisions. People received support that was individualised to their specific needs. Care plans were kept under review and amended as changes occurred.

The registered manager and staff team monitored people's health and wellbeing and took appropriate action as required to address concerns. Professionals agreed the service worked well with other organisations, helping people maintain their health and wellbeing. The service assessed risks to people's safety, as well as to staff and visitors and plans were in place to minimise those risks. Safe medicines administration systems ensured people received their medicines when required.

The registered manager had quality assurance systems in place to monitor the quality of the service being delivered. The registered manager identified any issues and improvements necessary and took action promptly to address these. We received a mixture of feedback from people and relatives about level of skills of some staff and the support they provided. The registered manager took this on board and provided us with an action plan to address each part of the feedback. Some staff felt certain aspects of the service could be improved such as travel time, length of training and workload. But they agreed they felt supported and could ask for help. The registered manager praised the staff team for their hard work and appreciated their contribution to ensure people received the best care and support. They promoted an open and inclusive culture within the service where staff felt supported and able to approach the management.

Further information is in the detailed findings below.