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Your Choice 4 Care is a domiciliary care agency providing personal care and support to people 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, the service was supporting 8 people, 6 of whom were receiving personal care.

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

There was an increase in governance and oversight since the last inspection. Governance systems had improved the safety of the service through appropriate inductions, training, competency and spot checks. Risk assessments were in place with care plans having detailed guidance in place to support staff to meet people’s needs.

Although there was increased oversight of the service, we continued to identify issues with medicine records, staff recruitment and competency records, late calls and lack of accident and incident monitoring systems. Further work was required to fully address concerns we identified at the last inspection.

Some medicines records were not always accurate. This placed people at risk of having their medicines administered incorrectly.

People were positive about the support from staff and their caring approach. Most people felt communication had improved if staff were going to be late. However, it was acknowledged that care staff were still late. The provider had not taken identified or taken action to address continued late calls.

Improvements had been made to the processes in place for infection prevention and control. Staff had a better understanding and knowledge of government guidance in relation to personal protective equipment.

The registered manager was completing daily checks of records and monitoring records showed shortfalls were being addressed with staff. Staff confirmed any shortfalls regarding logging in, content of daily records and not completing daily notes was followed up with them straight away.

People and staff had completed questionnaires about their experiences of the service. Further collation of responses and analysis had yet to be created.

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 inadequate (published 17 March 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 17 March 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced focused inspection of this service on 21 December 2020. Breaches of legal requirements were found. We issued a Warning Notice and placed conditions on the providers registration. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm whether the conditions on registration and the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Key Questions safe 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 has changed from Inadequate to 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 Your Choice 4 Care 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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines and governance systems at this inspection. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Your Choice 4 Care is a domiciliary dare service providing care and support to people in their own homes. At the time of inspection, Your Choice 4 Care were delivering care and support to 13 people. 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.

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

The provider failed to operate effect systems to monitor the quality and safety of the service. As a result, we identified significant shortfalls in relation to infection control which placed people and staff at increased risk of harm given the COVID-19 pandemic. We also identified serious failings relating to record keeping, management of medicines, insufficient staffing numbers, staff training and recruitment, safeguarding and failure to notify CQC of notifiable incidents.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staffing levels were not sufficient to ensure people received their care and support at the correct times and for the correct duration of time.

People and their relatives provided consistent, negative feedback about their experiences. One relative told us, “We have raised concerns about call times, my relative should have time critical medication but I regularly have to make sure my relative gets this on time.” Another relative described their experience as ‘chaotic’, stating they often had to cancel calls because they did not know if or when staff would arrive.

The provider was unable to demonstrate any analysis of themes and trends or how learning was shared with the staff team to ensure continuous improvement.

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 the service was Good published (27 August 2019).

Why we inspected

We received concerns about missed and late calls, the management of medicines, staffing levels, poor management and staff member concerns about training. 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 inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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 Your Choice 4 Care 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding, staffing, good governance and failure to notify the Commission of notifiable incidents.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This means we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Your Choice 4 Care is a domiciliary care service providing personal care to people 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 inspection, three people were receiving personal care.

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

Recruitment checks and records were not always robust.

People told us they felt safe with the staff who supported them. People were supported by a consistent staff team. Medicines were managed and administered safely. Where risks were identified they were assessed and mitigated.

Peoples needs were assessed prior to them receiving a service and reviewed regularly. 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.

People were supported by kind and caring staff who treated them with respect. People’s independence was encouraged.

People were involved with the development of their care plans and received personalised care.

People were happy with the care they received. People who received a service and staff were consistently positive about the registered manager.

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

Rating at last inspection

This service was registered with us on 12 December 2018 and this was the first inspection.

Why we inspected

This was a planned inspection based on our inspection schedule.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.