Raystra Healthcare

Updated 11 October 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 Health and Social Care Act 2008.

Inspection team

Two inspectors carried out this inspection.

Service and service type

This service is a domiciliary care agency and supported living service. It provides personal care to people living in their own houses and flats. It also provided care and support to people living in a ‘supported living’ setting, so they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. Two managers were registered with the CQC as registered managers of the service. One of these was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

This inspection was announced.

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 11 August 2022 and ended on 16 August 2022. We visited the location’s office on 11 August 2022.

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 authorities which commission care from the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with three people who used the service and the relatives of two more people who used the service to gain their feedback on the service provided. We spoke with three care staff and both registered managers. We reviewed four people’s care records. We reviewed three staff recruitment files and the staff training record. We reviewed records and discussed the systems in place for the management of the service.

Follow up

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

Updated 11 October 2022

About the service

Raystra Healthcare Limited is a domiciliary care agency and supported living 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 our inspection there were 37 people using the service.

People’s experience of using this service

Although various aspects of the service, including people’s care delivery, staff practices, staff training and complaints were monitored, these processes had not identified the shortfalls identified during this inspection. These shortfalls had not impacted on the service people received and had not put people at risk. The provider however, needed to review how they completed their monitoring of the service, to ensure their system was effective in identifying shortfalls and responsive enough to address areas for improvement.

We have made a recommendation in relation to quality monitoring.

We found two people’s care plans and risk assessments did not reflect their current needs. When discussed with the registered managers, they took immediate action to address these. They also started to make other alterations to, for example, the staff training record, so it captured information which would support improved monitoring of the service. Time was needed for the provider to implement a more formalised quality monitoring system.

People and the relatives we spoke with, told us they were happy with the care provided by the agency staff. There were arrangements in place to assess people’s needs and identify and support associated risks. A relative confirmed this process had taken place when their relative had been referred to the agency for support, and we saw reference to this when inspecting people’s care records.

Guidance was given to staff on how to manage people’s risks and on what care activities needed to be provided during a care visit. Care staff confirmed this when we spoke with them.

Care visits were allocated to staff through the adopted electronic system and monitored by senior staff to ensure they were completed along with the required care activities.

Where people’s needs were complex or where needs had altered, staff worked hard to liaise with external health and social care professionals to get appropriate assessments completed so care could continue safely. In two people’s cases, staff had struggled to get appropriate assessments completed. However, staff had continued to provide people with the care they required, and the support needed to lower risks to the people’s health and wellbeing.

Apart from the shortfall in two people’s care plans and risk assessments (identified during the inspection) care plans and risk assessments were generally available to staff for guidance. All information about people’s care and support needs was provided through the service’s electronic system which staff could access when they were mobile.

Registered managers were fully up to date on the support people required, including any changing needs, as they liaised with senior staff and monitored staffs’ care entries on the electronic system. This ensured the registered managers could support staff with any changes in people’s care and risk management and, where needed review with commissioners, the need for any necessary changes to people’s care visits.

The provider’s recruitment process included appropriate checks which were completed before staff worked with people. The results of these checks helped the registered managers make safer employment decisions.

Staff were provided with training when they first worked for the agency and thereafter to support safe working practice. Spot checks took place to monitor the quality of care and support provided to people. Staff knew how to report any concerns they had related to poor practice. When poor practice or behaviours which did not meet with the provider’s values were identified, the registered managers took action to address these.

The provider had safeguarding processes in place which staff received training on; staff told us they knew how to raise safeguarding concerns. The registered managers ensured they adhered to local authorities safeguarding protocols; sharing relevant information with appropriate agencies as required. There were checks in place to ensure potential risks, such as self-neglect through refusal of personal care, were also identified and reduced.

People’s needs, in relation to their medicines, were assessed and where support was required with medicines, this was provided by staff who had received relevant training.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 3 February 2022).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the initial assessment of people’s care needs, when a referral is made to the agency for emergency care support and, how information is made available to care staff prior to them providing that support. This inspection examined those areas of risk.

We found no evidence during this inspection that people were at risk of harm from the themes associated with this concern. Please see the safe and well-led sections of this full report.

This was a focused inspection only looking at the key questions, safe and well-led. 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 remains based on the findings of this inspection. However, We have found evidence that the provider needs to make improvements. Please see the well-led sections of this full report.

The provider started to take immediate action to make the improvements required at the time of the inspection.

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

Recommendation:

We have made a recommendation in relation to quality monitoring.

Follow up

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