Candy Healthcare Recruitment Ltd

Carebridge Staffing Ltd is a domiciliary care agency registered to provide both personal care and nursing care for treatment of disease, disorder or injury. The service supported adults and children living in their own homes in Kent, Hertfordshire, London and Surrey. Some people needed support with personal care; this is help with tasks related to personal hygiene and eating. Other people had more complex medical conditions and needed support from nurses. CQC only inspects where people receive personal care and/or nursing care. Where they do, we also consider any wider social care provided. At the time of our inspection 113 people were being supported with personal care or nursing care.

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

The service had expanded significantly since our last inspection and had recently gone through several staff changes in the senior management team.

Systems and processes around risk management needed to improve and that meant people were not supported in a consistently safe manner. This included risks associated with COVID-19 testing of staff and risk assessments of variable quality.

Audit and quality assurance processes were not sufficiently robust and had not identified the inconsistencies in some documentation and practice which were identified during the inspection. The provider was transparent about these areas where improvement was still required and was responsive to our feedback during the inspection. One staff member said, “We recognise there are areas we need to improve.”

The provider had a process to manage potential safeguarding concerns, alongside incidents and accidents and complaints. This process was mostly effective in identifying potential safeguarding concerns though we highlighted two issues to the provider during our inspection, which they responded to. People told us they knew who to contact if they had any concerns, though feedback from people was mixed in terms of how their concerns were responded to.

Staff knew how to recognise the potential signs of abuse and knew what action to take to keep people safe.

People were supported to maintain their health and access to health care services when they needed to. Staff and professionals told us the service sought appropriate guidance and support to maintain people's health and well-being.

People received care and support from trained staff who knew them well. The service employed both carers and qualified nurses for more complex care. There was enough staff to support people safely and the provider had safe recruitment procedures and processes in place. People received their medicines safely from staff who were trained and competent to do so.

Staff told us that while the service had been through a recent period of change, they felt supported. One member of staff said, “There’s room for improvement but I enjoy my job, I like serving people.” Another said, “They’ve given us such opportunities, all the support behind us.”

The service had a philosophy of “Care First”. People told us the staff who supported them were caring. One person said, “The carers are very, very good.” Another person said, “They know what to do, they are attached and loving and well trained.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well- led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches of regulation 12 (safe care and treatment) and regulation 17 (good governance] of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress.

Carebridge Staffing Ltd is a domiciliary care agency providing care and support to adults and children living in their own homes in London, Essex and Hertfordshire. Whilst we have taken into account any wider social care and support provided to people in their homes and in the community, the CQC carried out this inspection only in relation to the regulated activities of 'personal care' and 'treatment of disorder, disease or injury'. 22 people were using the service on the first day of our inspection. On the final day, 20 people were receiving a service. Nearly all of these people required support with personal care tasks.

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 provider had systems in place to assess people's care needs and to plan their care in a way which met their needs.

People were not always being protected from avoidable harm because potential risks to people and/or others were not being identified through a robust risk management process.

The provider made sure that people's capacity was assessed and that care was delivered in people's best interests.

The provider had appropriate medicine’s policies and procedures in place. This included assessing the support people required to take their medicines safely and as prescribed. Staff completed appropriate medicines training and competency assessments before supporting people with their medicines. Staff completed medicines administration records (MARs) and these were returned to the office for auditing purposes.

The provider operated safe recruitment measures. The provider obtained sufficient proof of identification, requested and verified employment references and carried out Disclosure and Barring (DBS) checks before staff started work.

The provider carried out appropriate training and spot checks to ensure that care workers were suitable for their roles and had the right skills to care for people. At the time of our inspection there were enough nursing and care staff deployed to support people with their needs.

There were measures in place to ensure that staff understood how to promote people's dignity and this was regularly checked by managers. People told us that they were treated with respect by staff.

The provider gathered information and took account of people's cultural needs and preferences to ensure staff supported people in an appropriate manner.

People received support to eat and drink where this formed part of an agreed package of care.

Most people had regular reviews of their care and the management team sought people’s feedback to make sure they were happy with the standard of care provided.

When incidents had taken place or complaints had been received, managers acted on these and investigated what had taken place. Staff told us that incidents, accidents, concerns and complaints were discussed at team meetings and in supervision sessions with a view to promoting understanding and learning.

Staff were positive about the support and guidance they received from the registered manager and her team.