Background to this inspection
Updated
4 December 2020
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 Care Act 2014.
Inspection team
This inspection was carried out by one inspector. A visit to the office was made on 27 October 2020. An expert by experience made telephone calls on 27 and 28 October 2020 to a sample of people who used the service and relatives. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Further evidence was reviewed off site between 28 October 2020 and 04 November 2020.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
The service had a manager registered with the Care Quality Commission. 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.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a domiciliary care service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from a commissioner of the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We contacted staff by email to request feedback about the service.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We spoke with the registered manager, the operations manager and a compliance officer.
We spoke with 12 people who use the service and six relatives.
We reviewed a range of records. These included people’s care plans, medicines records, staff recruitment files and staff training and development files. Other records included those which related to monitoring and auditing of the service and complaints.
After the inspection
We reviewed information we asked the registered manager to send to us.
Updated
4 December 2020
About the service
All Care (GB) Limited - High Wycombe Branch is a domiciliary care agency providing support to people in their own homes. 201 people were using the service at the time of the inspection. People’s needs ranged from younger adults with disabilities to older people and people with dementia. 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
At our last inspection, we found regular occurrences where care workers were not staying the full length of time that was scheduled. At this inspection, we found the provider had not made improvement. This meant people were at risk of not receiving all the support they require or care workers may be hurrying to do things.
Six people we spoke with commented on the timing of their calls (visits) being late or unsuited to their needs, and different care workers coming at weekends. However, they were satisfied with the service overall. People said they were usually informed by the office if care workers were running late.
People spoke positively about the care they received from the service. Typical comments included, “I couldn’t do without them…I don’t feel rushed and they do have time to chat and ask how I am and if I need anything,” “I feel safe with them” and “I find the carers are always gentle with me.”
People were supported by care workers who had appropriate recruitment checks. People told us they felt safe. Staff undertook an induction and received training to help them support people safely. This included training on safeguarding people. Appropriate safeguarding referrals were made to the local authority, when necessary.
Care plans were in place for each person, outlining their needs and how to support them. Risk assessments had been written, to reduce the likelihood of people suffering injuries or harm during their care. Infection control measures were in place including those on managing the COVID-19 pandemic. Staff had access to all the personal protective equipment (PPE) they required.
Improvement had been made to safe management of medicines since the last inspection. People told us care workers managed their medicines effectively. For example, “I get my pills delivered and they check that I have taken them correctly” and “They put my tablets out ready for me in the morning and evening. They drop my prescription in for me and then the tablets are delivered.”
Improvement had been made to complaints handling. The people we contacted told us their complaints and concerns were listened to. People knew how to make a complaint either to the service or the local authority, who commissioned their care. We saw examples where the service apologised, where necessary, and let people know what action had been taken in response to their complaint. However, three people had contacted us independently of the inspection process with negative experiences of making complaints. We have made a recommendation regarding customer care practice.
The service had a registered manager in post; this was a change to leadership since the last inspection. A range of monitoring took place at the service and by senior management. A quality audit was carried out by an external company in February 2020, highlighting areas where improvement was suggested. Some areas had been addressed and others were on-going.
The service was responsive to people’s changing needs and liaised with relatives and external agencies to promote their welfare.
We have made recommendations around duty of candour, to ensure the service fully meets its obligations when things go wrong, and the Accessible Information Standard.
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 requires improvement (published 14 June 2019).
Why we inspected
We carried out an announced comprehensive inspection of this service on 25, 26 April 2019 and 8 May 2019. Breaches of legal requirements were found at that time, regarding handling complaints, management of medicines and providing safe care and treatment. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and receiving and acting on complaints.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for All Care (GB) Limited - High Wycombe Branch on our website at www.cqc.org.uk.
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. We will continue to monitor the service.
We have identified a continued breach in relation to safe care and treatment, due to the number of occasions where care workers had not supported people for the full duration of their scheduled visits.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.