Background to this inspection
Updated
6 November 2021
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
The inspection was undertaken by two inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It also provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.
The service currently has two managers 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.
We gave the service 24 hours’ notice of the inspection. This was because we wanted to be sure the registered managers and staff were available to speak with us at the site visit.
Inspection activity started on 18 August 2021 and ended on 1 September 2021. We visited the office location on 18 August 2021.
What we did before the inspection
We reviewed the information we had received about the service since the last inspection. We sought feedback from the local authority and health and social care professionals who work with 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 this information to plan our inspection.
During the inspection
We spoke with 20 people who used the service and six relatives about their experience of the care provided. We spoke with 14 members of staff including both registered managers and two office staff. We also spoke with five commissioning, purchasing and operational representatives from the local authority and received feedback from two representatives from health.
We reviewed a range of records. This included six peoples care records multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A range of records relating to the management of the service, staff training, complaints, staff and user surveys were reviewed.
Updated
6 November 2021
About the service
All Seasons Community Support Two Limited is a domiciliary care agency. It provides personal care to adults living in their own houses and flats in the community. The service also provides support to two extra care housing blocks where people live in their own flats but have access to 24 hour care support from All Seasons care staff. Most people using the service were older people. At the time of the inspection the agency was supporting 338 people, of whom 325 were receiving personal care.
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
There were quality monitoring systems in place and these had identified communication, with and from the office, as an area for improvement. Actions taken to address this had not been sufficiently effective. People told us they were still experiencing difficulties in contacting the office “I have to pick my times of trying to get through”. A staff member told us, “If you think a call is too late for a client and call the office like I did once to get told by someone in that office well if they don't like it leave.” People also said they sometimes found responses to them by office staff, “grumpy, “sarcastic”, or “unsympathetic”.
The impact of the pandemic has led to staffing recruitment and retention issues with a number of unfilled hours. A number of people spoke about the lateness of calls and the impact this had on their needs being met in a timely way bordering on neglect and placing them at risk of harm.
Learning from incidents, accidents and safeguarding was not always disseminated widely to all staff to ensure consistency in good practice.
There was a complaints system in place that showed formal complaints were investigated thoroughly. However, people told us that often their informal complaints and concerns made to office staff went unanswered “I’ve given up I go through my care manager now.”
People universally told us they felt safe with staff and their privacy and dignity was respected. People spoke positively of carers kindness, professionalism and the quality of support they provided them with. “I couldn’t be treated better if I were royalty.” “It’s a very good thing to have a nice carer every morning, otherwise I would be very lonely, it’s a valuable service.” Staff were trained to recognise, and report abuse and the service had been proactive in doing so where necessary.
Medicines were managed safely with some minor suggestions for improvement. We have made a recommendation about the management of some medicines. Staff were given appropriate induction and training to undertake their role and were recruited safely.
Enough personal protective equipment (PPE) was made available for staff who told us they wore and changed this for every call, they had received training and additional information about COVID-19 and understood the importance of being fully protected.
Staff survey information and staff spoken with at inspection indicated the majority of staff felt supported and valued. Staff found the management team approachable and spoke positively about some of the incentives they were given including an employee assistance programme.
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 2nd May 2019).
Why we inspected
The inspection was prompted in part due to concerns received regarding poor practice/poor care delivery by staff and issues with privacy and dignity, medicine errors, inadequate staffing, missed and late calls and lack of staffing continuity.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective 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.
The provider had already taken some remedial actions to address the staffing shortages. These included reducing the number of new care packages taken on in order to be able to support existing clients. Tackling habitual sickness amongst staff. Client routes were also under review to see if these could be more effective and lessen the number of late calls.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
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 Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.
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.