Archived: All Care (GB) Limited - High Wycombe Branch

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.

People’s experience of using this service:

People told us they did not receive a service they could rely on. This was because the timings of their visits by care workers (calls) were erratic, sometimes late and sometimes missed. People who required two care workers told us two were not always provided, which meant they could not be hoisted out of bed. This impacted on their independence. Following the inspection, the provider sent us records to show that for the four weeks prior to the inspection, all visits which required two care workers were carried out by two workers.

People told us care workers did not always stay the agreed amount of time supporting people. This was confirmed by looking at the service’s computer records. In some cases, this was far shorter than the scheduled length of time. We have shared this information with the local authority. Some of the feedback we received was that care workers were rushed. Some people told us care workers did not always promote good hygiene when they supported them.

Due to the erratic nature of some calls, people did not always receive their medicines within safe intervals if they required more than one dose a day. On some occasions, doses were given too close together.

Staff knew about safeguarding people from abuse. Concerns were referred to the local authority and to us, when required.

Robust recruitment procedures were used at the service. There were systems to supervise and train staff, to help ensure they had the skills to meet people’s needs.

People’s needs were assessed before they received a service. Care plans had been written and were kept up to date. Risks were assessed and measures were put in place to help keep people safe. The service had not always assessed people’s capacity to consent to their care, in line with legislation. Copies of Lasting Power of Attorney documents had not always been obtained, to prove others who acted on people’s behalf had the authority to do so.

People had mixed experiences about being treated with respect by care workers. This was also the case with their privacy, dignity and independence.

People told us they did not feel listened to. They said their calls or emails to the office were not always returned.

The service worked in partnership with other agencies such as healthcare professionals and the local authority. The registered manager kept their own learning up to date and attended local forums to share good practices.

Monitoring was undertaken by the provider and registered manager. This included ‘spot checks’ of care worker practice out in the community, surveys and audits. A mock inspection had been carried out by the provider a couple of days before our visit. It had not identified the areas where we found improvement was needed. Some actions had been taken to improve the service. These had only been introduced very recently and had not had time to become embedded in practice.

There were examples of where people had not received the care they expected from the service. These could have been managed using the duty of candour principles, which aim to ensure providers always act with openness and transparency.

We have made recommendations about infection control and hygiene practices, implementation of the Mental Capacity Act (2005) code of practice and demonstration of the duty of candour principles.

Rating at last inspection: This was the service’s first inspection since changes to registration in November 2018.

Why we inspected: The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: We found areas of practice where the provider was not meeting the regulations. These were in relation to management of people’s medicines, handling of complaints and care workers not staying the full amount of scheduled time to carry out all the required care tasks.

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will ask the provider to submit an action plan which outlines what they will do to improve the service and by when. We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

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