Background to this inspection
Updated
14 September 2022
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 Health and Social Care Act 2008.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 21 July 2022 and ended on 27 July 2022. We visited the location’s office on 21 and 27 July 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with four people and four relatives about the quality of care and support provided. We spoke with five staff, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included four people’s care records and multiple medicines records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
14 September 2022
About the service
Safe Choice Care is a domiciliary care agency which provides care and support to people in living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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 the inspection 70 older people were receiving support with personal care.
People’s experience of using this service and what we found
People were not supported by staff who had been safely recruited. Gaps in previous employment had not been explained. People’s views about the timing of care calls varied and there was not always travel time factored in between calls.
Risks to people’s health, safety and welfare had not been consistently assessed to make sure measures were in place to reduce the risks.
People were not always supported by staff who understood the importance of robust infection control measures. Staff re-training had been completed and the monitoring of staff increased.
People received their medicines as prescribed. When there had been medicines errors, these had been investigated and action taken to ensure it did not happen again. When people required medicines on an ‘as and when’ basis, the guidance for staff had not been consistently completed.
Checks and audits on the quality and safety of the service were not consistently effective. The registered manager’s checks had not identified the shortfalls found during the inspection. Checks had not been completed to make sure staff stayed the length of time they should, and no checks were made to ensure travel time had been allotted.
People and their relatives generally spoke positively about the quality of service they received. Staff felt valued and felt supported by the management team.
Staff worked closely with health care professionals, such as community nurses and GPs. People were referred to health care professionals when needed to ensure they received the support they required.
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.
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
The last rating for this service was requires improvement (published 14 June 2019).
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 the provider remained in breach of regulation.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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 Safe Choice Care on our website at www.cqc.org.uk.
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 recruitment of staff, risk assessments and good governance.
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 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.