We carried out a review of the data available to us about Careful Care Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Careful Care Limited, you can give feedback on this service.
Careful Care Limited is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection 69 people were supported with their personal care needs.
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
At our previous inspection in November 2020, we found that effective systems were not being used to manage people’s risks and monitor the quality of care being provided. Records relating to people’s care and staff recruitment were not always complete and contemporaneous.
However, during this inspection, we found the provider had acted on our feedback and implemented their action plan and the regulatory requirements were now being met. There was evidence that the provider had improved their processes to assist them in the monitoring of people’s care.
Each person’s care needs had been comprehensively reviewed and documented. Staff had access to the information they needed to support people and the actions they should take to help mitigate and monitor people’s personal risks. Medicine care plans described people’s prescribed medicines and creams and dosages.
People reported that safe infection control practices were used when they were supported by staff. Staff had access to personal protective equipment and were aware of their responsibility to minimise the spread of infections.
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.
Systems to safely recruit staff had been reviewed and implemented. People were supported by sufficient numbers of staff who had been vetted and assessed as being of good character and competent before they provided care to people.
The registered manager worked in partnership with people, their families and health care professionals to achieve good outcomes for people and sought their feedback.
Quality assurance systems had been reviewed and developed to assist the registered manager in the monitoring the quality of care being provided and the management of staff. However further time was needed to ensure that the systems implemented were fully embedded and that their quality assurance findings were recorded in more detail such as the observations of staff care practices.
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 8 January 2021) and we identified two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
We carried out an announced focus inspection of this service on 11,12,13 November and 8 December 2020. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to safe care and treatment and good governance.
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 ‘Is the service 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 Requires Improvement to Good. 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 Careful Care Limited on our website at www.cqc.org.uk.
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.
Careful Care Ltd is a domiciliary care service that provides personal care and support to people living in their own homes. The service supported 80 people at the time of the inspection.
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
Careful Care Ltd provides care to people in their own homes in the rural area of the Cotswolds. The provider and registered manager monitored the care people received through feedback from people and observations of staff care practices. However further quality assurance checks were needed to ensure the service fully complied with legal requirements.
People were potentially at risk of receiving unsafe care and support as the provider had not always ensured that the assessment of people’s risks and risk management plans were in place to guide staff on the best ways to support people and assist in mitigating people’s risks.
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. However, we have made a recommendation that the provider seeks further guidance in obtaining people’s consent in line with the principles of the Mental Capacity Act (2005).
The provider carried out employment and criminal background checks as part of their recruitment process, however more details of the recruitment process were needed to demonstrate that the registered manager was satisfied that new staff were of good character and fit to work. We have made a recommendation around the records relating to staff employment and criminal background checks.
Staff told us they felt trained and supported and were confident that the registered manager would address any concerns around their personal development and the safety of people who use the service.
People were supported by small consistent staff teams who were familiar with their needs. People complimented the staff and confirmed staff were kind and provided care which was personalised and responsive to their needs.
Staff were aware of their responsibilities to record and report any concerns of abuse, accidents, incidents and near misses.
The provider and registered manager were passionate about delivering good quality care to people. They were open to learning and making improvements to the service. People’s feedback and complaints were acted on and seen as an opportunity to learn and drive 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 this service was Good (published 28 June 2018).
Why we inspected
This was a planned focused inspection based on the previous rating. This report only covers our findings in relation to the Key Questions Safe and Well-led.
The ratings from the previous comprehensive inspection for the other key questions we did 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 good 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 Careful Care Limited on our website at www.cqc.org.uk.
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.
During this focused inspection we have identified breaches in relation to the management of people’s risks and medicines and the effectiveness of the services governance processes 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.
Not everyone using Careful Care Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
We heard positive comments about the service. People’s relatives told us they were, “Really happy” and “Very pleased” with the service provided.
At our previous inspection in October 2015 the service was rated “Good”. At this inspection we found the service remained “Good”.
Careful Care Limited had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People were protected from harm and abuse through the knowledge of staff and management. Risks to people's safety were identified, assessed and appropriate action was taken to keep people safe. Sufficient staff were deployed to meet people’s needs and improvements to staff recruitment procedures were in progress.
People were treated with respect and kindness. Their privacy and dignity was upheld and they were supported to maintain their independence.
People were supported by staff who had training and support to maintain their skills and knowledge to meet their needs. People were supported to have maximum choice and control of their lives and staff support in the least restrictive way possible; the policies and systems in the service supported this practice.
People received personalised care from staff who knew their needs and preferences. People and their relatives were involved in the planning and review of their care and support. There were arrangements in place to respond to concerns or complaints. Care was provided for people at the end of their life.
Quality assurance systems were in operation with the aim of improving the service in response to people's needs. A survey had been completed to gain the views of people and their relatives about the service provided. The management were approachable to people using the service, their representatives and staff.
Further information is in the detailed findings below.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
This inspection took place on 1 October 2015 and was announced. Careful Care Limited provides domiciliary care services to people who live in their own home. At the time of our inspection there were 24 people with a variety of care needs, including people with physical disabilities, Parkinson's and the early onset of dementia using the service.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
Everyone we spoke with was complimentary about the service. People spoke highly about the care staff and valued having regular care staff which enabled them to build caring relationships. People and their relatives spoke positively about the registered manager.
There was a positive caring culture, promoted by the registered manager. Staff were passionate about providing high quality care and clearly enjoyed supporting people. Care staff felt supported by the registered manager, describing them as approachable and supportive both personally and professionally.
Staff were knowledgeable about the people they supported and had access to development opportunities to improve their skills. Staff received specific training where it was required to support individual needs.
People's needs were assessed and where any risks were identified, management plans were in place. People were supported in a way that recognised their rights to take risks. People's care was personalised to their needs.
The service was responsive to people's changing needs and made sure people had their visits when they needed. Staff ensured people's relatives were informed of any concerns. Staff were trained to identify when people's needs had changed.
There were systems in place to enable the service to gather feedback from people. Quality assurance systems were in place to enable the service to identify areas for improvement. People and their relatives were asked for their views.