Staffordshire

Staffordshire is a home care service providing personal care to adults with a range of support needs in their own homes. At the time of the inspection there were 24 people using the service, some of whom had a learning disability.

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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

The provider had made significant improvements since our last inspection, and they were no longer in breach of regulations. However, further improvements were still required to ensure the systems in place were always effective.

Right Support: We found improvements were required to ensure the provider supported people in line with the restraint reduction standard. People were supported to have maximum choice and control of their lives however, further guidance was required to ensure staff clearly recorded how they supported them in the least restrictive way possible and in their best interests; the policies and systems in the service required further review to support this practice.

Right Culture: Since our last inspection, systems in place to improve the service had been implemented, however further improvements were still required. The systems to identify missed calls were not always effective. The provider had not ensured all required referrals were made. People’s care records had however, been reviewed to ensure people received calls in line with their care plan. Staff shared a positive culture which was person centred and they were encouraged to be open and honest when things went wrong. People, their relatives and staff were involved and engaged in the service.

Right Care: The provider had made improvements since our last inspection to ensure staff were recruited safely and people’s medicines were managed safely. People’s care plans detailed how their care was person centred and promoted their dignity. People were protected from the risk of infection through effective control systems in place. Lessons were learnt when things went wrong.

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 June 2022) and there were breaches of regulation. The provider had received a warning notice following the last inspection and they had to be compliant with this. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider 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 and well led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Staffordshire on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Staffordshire is a home care service registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported 34 people.

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

Whilst some improvements had been made, further improvements were needed to ensure the quality and safety of the service was monitored effectively. Improvements were needed to recruitment processes to ensure staff were safe to support people. Lessons had not always been learned when things went wrong. People received their medicine, but improvements were needed to documentation and the intervals between medicine doses for one person.

The registered manager (who was also the provider), failed to provide documentation or submit a Provider Information Return (PIR) on time. Staff did not always complete training in an appropriate length of time, a course that should take approximately 12-week course was being completed within days.

People generally received their calls on time. People felt safe with staff and felt well supported. Safeguarding concerns were reported as appropriate. People were protected from the risk of infection as staff wore PPE, however there was no evidence of systems in place to monitor staff COVID testing.

The registered manager was aware of their responsibility of duty of candour. They were open to feedback and wanted to improve. Staff felt supported in their role and people said they would recommend the service to others.

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 7 January 2022) and there were breaches of regulation. The provider had received warning notices following the last inspection and they had to be compliant with these. The provider was also required to send us a monthly update after a previous inspection in May 2021 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.

Why we inspected

We undertook a targeted inspection to follow up on action we told the provider to take at the last inspection and to ensure they now met legal requirements. We inspected and found there was a continued concern in relation to recruitment and governance systems, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 remained the same, 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 Staffordshire on our website at www.cqc.org.uk.

We found evidence that the provider needs to make improvements. Please see the safe, and well-led sections of the full report.

You can see what action we have asked the provider to take at the end of the full report.

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 two breaches of regulation at this inspection. The provider had continued to fail to make enough improvement to recruitment processes so there were ongoing concerns. The providers governance systems had failed to recognise some improvements were needed.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Staffordshire is a home care service registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported 36 people.

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

Improvements were needed to recruitment processes and recording to ensure all necessary information was considered and clearly documented. Quality assurance systems had failed to identify this. There was mixed feedback about staff arriving on time, but people were generally visited by a consistent staff team. However, the rotas did not always match the care being delivered, which increased the risk of missed visits, although we found no harm had come to anyone as a result of this. Systems in place had failed to identify some calls were too close together to be able to administer medicines. No one had come to harm, but this had not been recognised.

People were protected as staff wore appropriate Personal Protective Equipment (PPE), however staff were not always carrying out the necessary COVID-19 tests and the registered manager’s systems in place had not recognised this.

People told us they felt safe. Improvements had been made to people’s care plans and risk assessments as they were more detailed and risks to people were assessed. People received their medicines as necessary and information was available for ‘when required’ medicines. Staff and the registered manager understood their safeguarding responsibilities.

People and staff were asked for their opinion about the service. Staff felt supported in their role and were engaged in the service and kept up to date with changes. Staff were positive about the registered manager and felt they were listened to.

The registered manager was aware of their duty of candour and acknowledged further improvements were needed to the service but were working on these.

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 5 May 2021). The provider was required to send us a monthly update 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.

Why we inspected

We received information from another government agency about concerns they had about some staff working at the service. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to assessing risks, medicines management and recruitment of staff.

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 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 remained the same, 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 Staffordshire on our website at www.cqc.org.uk.

We found evidence that the provider needs to make improvements. Please see the safe, and well-led sections of the full report.

You can see what action we have asked the provider to take at the end of this full report.

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 two breaches of regulation at this inspection. The provider had failed to make enough improvement to recruitment processes so there were ongoing concerns. The providers governance systems had failed to recognise some improvements were needed.

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

Staffordshire is a Domiciliary Care Agency (DCA) registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported approximately 19 people with personal care 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.

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

People’s risks were not effectively managed. Some people who had specific health care needs did not have this recorded in their care plans. Although people told us they received their medication, the provider did not have ‘as and when required’ medication protocols in place and the recording was not robust. People needing topical creams applying did not have this effectively recorded.

New staff had been employed without the required references in place and were not always adequately trained before carrying out care calls. This put people at risk should they need support in being moved.

People’s care plans lacked detail in relation to their requirement of needs and information contained within some care files was contradictory. This meant new care staff could become confused and misunderstand people’s required needs.

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

Governance systems were not robust and did not support the improvements needed to the service.

People told us they felt safe and gave positive feedback. Relatives also gave positive feedback about the care their loved ones received from the service.

There was a positive culture amongst the staff, they told us they felt supported in their roles and enjoyed working for the service.

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 12/03/2019 and this was the first inspection.

Why we inspected

Our intelligence and monitoring systems highlighted to us the service was high risk. As a result, we undertook a comprehensive inspection as the service had not been previously inspected.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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.

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 five breaches of regulation. The provider had not ensured people’s medicines were managed safely and their risks were not always identified (Regulation 12). The provider had failed to ensure people’s Mental Capacity had been effectively assessed and could not evidence if people had Lasting Powers of Attorney in place to allow others to legally act on their behalf. (Regulation 11). The provider failed to ensure sufficient pre-employment checks had been carried out prior to staff commencing employment and had failed to ensure staff were effectively trained to meet people's needs prior to carrying out care calls (Regulation 18). The provider had not ensured people’s care plans were consistently person centred considered people’s end of life wishes (Regulation 9). The provider had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided (Regulation 17).

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We requested 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.