13 July 2023
During an inspection looking at part of the service
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Joelma Limited is a domiciliary care agency providing personal care to adults in their own homes. 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 7 people were receiving support with personal care.
People’s experience of using this service and what we found
Right Support
Known risks to people's care were not always assessed fully and staff did not always have enough information to guide them in how to provide safe care to people. Recording of medicines processes was not always accurate. When people took medicines 'as needed' there was no guidance for staff to follow to support safe practice. Information about people's DNCAPR (Do not attempt cardiopulmonary resuscitation) decisions were not included in their care records so staff may not have access to accurate information in the event of a medical emergency. Recruitment processes required strengthening to ensure safe employment decisions could be made. Staff wore aprons and gloves when they supported people’s personal care to reduce the risk of cross infection.
Right Care
Staff were reliable, usually arrived on time and stayed the length of time they were supposed to. The registered manager intended for people to receive support from a small, consistent team of staff and were working towards this. People and relatives told us they/their family member received safe care from staff. Processes were in place to record and follow up accidents and incidents.
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 did not always support this practice. We have made a recommendation for mental capacity assessments to be undertaken when a person may have fluctuating capacity, to support best practice in people making decisions about their care.
Right Culture
Improvements were needed to quality assurance systems and processes. Audits did not always identify issues or record what actions were needed and subsequently taken to improve the service. The registered manager and staff team were keen to ensure people received good quality care in their homes. Positive feedback was received about the approach of the registered manager and the support they offered.
Staff were supported through team meetings and one to one supervision sessions. Feedback was sought from people informally and via questionnaires. The registered manager and staff team worked with health and social care professionals involved in people's care and treatment.
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 25 May 2019.)
Why we inspected
This inspection was prompted in part due to information received which suggested concern about aspects of the provider’s recruitment practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We did not find evidence of those particular concerns, but we did find other concerns in relation to recruitment.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full 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 Joelma Limited on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified a breach in relation to some aspects of people’s safe care and treatment at this inspection. We have made a recommendation for the provider to introduce mental capacity assessments when required.
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 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.