Icare Solutions (Wirral) Ltd

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 had been improvements to the quality and safety of the service. The provider now had oversight of risks when providing care for people and steps to mitigate these risks. These improvements were recent since the previous inspection in June 2021 and needed to be embedded and sustained over a longer period of time.

Medicines were managed safely and records of administration were accurately completed, however some call times did not allow for assurance that medication was administered as prescribed.

Where people required support to take their medicines, staff supporting them were trained in medicines and their practice was checked by the provider during spot check visits .

People did not always receive support at the scheduled times, for the planned length of time. This had a negative impact for some people, on the quality of care they received.

People had individualised care plans in place that were used to assess the risks identified in their care. These had been updated since our previous inspection. However, we found that they did always provide staff with guidance on how to care for people safely.

Staff also received induction when they first started in post, and the provider ensured they were competent for their roles before supporting people on their own. This had been updated since our previous inspection.

People and relatives told us that the service had improved since the previous inspection. They described how the service was now more reliable and having regular staff had a positive impact on their care.

There were enough staff to support people, which minimised risks to people who had consistent support allocated. Most staff told us they felt supported in their roles and people and their relatives found staff competent and kind. This has improved since our previous inspection.

The provider had ensured safe recruitment practices were now being followed fully.

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 26 July 2021). At this inspection we found that although some improvements had been made, the provider remained in breach of regulations regarding the management of medicines, risk management and the governance of the service.

Why we inspected

We carried out an unannounced inspection on 3 and 10 March 2022 following on from breaches that were found at the previous inspection in July 2021. The provider completed an action plan after the last inspection to show what they would do and by when to make improvements.

We undertook this focused inspection to check improvements had been made and if the provider 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 comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from inadequate 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 ICare Solutions (Wirral) Ltd on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing and the governance of the service at this inspection. You can see what action we have told the provider to take at the end of this full report.

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.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

ICare Solutions (Wirral) Ltd is a domiciliary care agency 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 the inspection, 78 people were receiving support with personal care.

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

Risk to people was not always assessed and managed appropriately. As a result, staff did not have access to accurate and up to date information regarding people’s support needs to maintain their safety. Risk assessments were not always accurate and when risks had been identified, actions had not been taken to minimise the risks. Care plans were not always updated to reflect changes in people's needs.

Medicines were not managed safely and people did not always receive their medicines when they needed them. Records of administration were not completed accurately or robustly; call times did not always allow for sufficient time between doses of medicines and medicines were not always administered as prescribed. Not all staff had had their competency to administer medicines safely assessed.

People did not always receive support at the scheduled times, by staff that knew their needs, or for the length of time the call was planned for. This had a negative impact on the quality of care people received. Not all safe recruitment checks were completed to ensure staff were suitable for the role.

Infection, prevention and control measures were not always followed to minimise risks both within the office and in people's homes. People told us care staff did not always wear masks and there was no evidence of staff being tested for COVID-19.

Systems were in place to monitor the quality and safety of the service, but they were ineffective. They did not identify all areas of the service that required improvement, were not always accurate and when actions were identified, the actions were not always completed.

People and their relatives did not always feel the service was well managed. They described lack of consistency, staff that did not know their needs and late or missed calls. However, people who received care from regular carers were more satisfied with the support they received.

Staff were aware how and when to report any safeguarding concerns they had and there was a policy in place to guide them. Records showed appropriate actions had been taken following accidents and incidents to reduce risk to people. Family members were informed when this happened.

CQC had been informed of incidents providers are required to inform us about. There were some systems in place to gather people’s feedback about the service, including staff meetings and quality assurance surveys.

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 inadequate (published 15 January 2021) and there were breaches of regulations identified in relation to risk management, staffing and the governance of the service. The provider completed an action plan 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. Please see the safe and well-led sections of this full report.

We inspected the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ICare Solutions (Wirral) Ltd on our website at www.cqc.org.uk.

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. 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 safe care and treatment, staffing, recruitment and the governance of the service at this inspection.

Follow up

The overall rating for this service is still ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

ICare Solutions (Wirral) Ltd is a domiciliary care agency 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 the inspection, 128 people were receiving support with personal care.

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

The systems in place to monitor the quality and safety of the service were not effective. They did not identify the issues we highlighted during the inspection and when actions were identified, it was not always clear if they had been addressed. This is a breach in regulation. The Commission had not been informed of all reportable incidents and events providers are required to inform us about.

Medicines were not always managed safely as records regarding administration were not completed accurately. Call times were not always scheduled to ensure medicines were administered as prescribed. Potential risks to people were not always assessed robustly or mitigated. These issues evidenced breaches in regulation.

There was not always sufficient staff to ensure people received support at the times it was scheduled and required. Staff were not allocated time to travel between calls and staff did not stay for the full duration of the planned calls. This is a breach in regulation.

Records showed that people were not always supported to have maximum choice and control of their lives, although staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Some systems were in place to record people’s consent, but they were not always adhered to. We made a recommendation about this in the main body of the report.

Staff received regular supervision and training. New staff completed an induction, but this did not fully meet the best practice requirements of the care certificate, to ensure staff had the knowledge and competence to support people effectively. Staff completed regular training, but this did not include training to support people living with dementia. We made a recommendation about this in the main body of the report.

Safe recruitment practices were followed, and staff told us they were well supported and enjoyed their roles. People knew how to raise any concerns they had and told us issues were usually dealt with once raised. Positive feedback was received from people and their relatives, in relation to the care provided by care staff.

The provider and registered manager have taken responsive action since the inspection to start addressing the concerns raised. They are also working closely with the local authority who are monitoring risk regularly.

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 22/10/2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received regarding the quality of care provision and infection control. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see full details in the individual sections 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 monitor the service.

We have identified breaches in relation to risk management, the management of medicines and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.