Background to this inspection
Updated
10 March 2022
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 carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
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 small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 16/12/2021 and ended on 21/12/202. We visited the office location on 16/12/2021.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. 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 and one member of staff. We reviewed care records and medicine records for one person. We looked at one staff file in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We spoke with one person and the person’s representative. We looked at quality assurance records and policies. We continued to seek clarification from the provider to validate evidence found.
Updated
10 March 2022
About the service
County Healthcare Services Limited is a domiciliary care agency registered to provide personal care to people living with dementia, learning disabilities or autism, mental health, older people, younger adults and sensory impairment. One person was receiving personal care at the time of the inspection.
People’s experience of using this service and what we found
Whilst people’s regular medicines had been given safely further improvement was needed around the records of medicines given on an ‘as required’ basis. The person was supported by staff who understood how to recognise and escalate safeguarding concerns should they have any.
Improvements had been made to the recruitment systems in place. Whilst we noted some improvement to care records people did not always have care records in place that reflected their needs.
Whilst some improvements had been made to systems that monitored safety in the service following our last inspection, we found they had not always been effective at identifying concerns. Further improvements were needed to ensure a robust, planned monitoring system was put in place to enable the provider to have oversight of the quality of people’s care.
People were happy with the care they received and felt safe. Improvements had been made in seeking feedback from people who received support from the service. Staff felt supported by 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
The last rating for this service was inadequate (Published 14/05/2021) and there were multiple breaches of regulation. We placed conditions on the providers registration for the requirement to send CQC monthly reports on key areas.
At this inspection enough improvement had been made to ensure staff were safely recruited and the provider was no longer in breach of this regulation. However enough improvement had not been made to the systems that ensure people receive safe care or in the monitoring of the service and the provider remains in breach of these regulations (Regulation 12, safe care and treatment and Regulation 17, good governance).
This service has been in Special Measures since 14 May 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
This was a planned inspection based on the previous rating.
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.
This inspection has identified a continued breach relating to the governance and oversight at the service and ensuring people received safe care and treatment. We will continue to monitor the improvement within the service through existing conditions we have placed on the providers registration. This includes sending us monthly reports of action the provider has taken to make improvements within the service.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.