Care Solution Bureau CIC

Care Solutions Bureau CIC is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to younger disabled adults and older people, some living with dementia. 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 the provider was supporting 280 people in the London Borough of Tower Hamlets.

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

Relatives told us how beneficial it was that care workers and office staff could communicate with them and their family members in their own language and understood their cultural requirements. One relative said, “We are so grateful for this. As they share the same language and culture, they’ve bonded so well.”

People and their relatives spoke positively about the kind and caring attitude of the whole staff team, including the registered manager. One relative told us they treated their regular care worker as part of their family.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People and their relatives felt safe using the service and told us staff prevented them from coming to any harm. We saw some minor inconsistencies in the records we reviewed related to risk assessments and financial transaction records.

People and their relatives were positive about the management of the service. They felt the registered manager was kind and approachable and were confident he would deal with any issues or concerns appropriately.

The provider had worked hard to make the necessary improvements from previous inspections to monitor the service and improve the performance of care workers recording responsibilities.

People were supported by a staff team that felt valued and appreciated, who praised the support they received and the positive work environment.

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 29 December 2018) and there was one continuing breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. They also submitted monthly audit reports to us. 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.

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.

People who used the service and their relatives told us that staff were kind and caring and treated them with dignity and respect. There was evidence that language and cultural requirements were considered when carrying out assessments and allocating staff to work with people.

People told us that they felt safe using the service and staff were confident that any concerns would be dealt with appropriately. The provider had just introduced a new electronic call monitoring system where staff logged in and out of their calls, which enabled care workers visits and punctuality to be monitored.

People and their relatives knew who to contact if they needed to make a complaint and people were happy with how their issues or concerns had been dealt with. Health and social care professionals felt the provider was responsive and responded to concerns positively.

People had regular care workers who knew how they liked to be supported. Care workers were aware of people’s dietary needs and supported people to maintain their health and wellbeing. We saw the provider had contacted the necessary health and social care professionals when people’s health deteriorated.

Although people told us that they did not have any concerns with how they were supported with their medicines, we continued to see inconsistencies in how records were completed. We saw the provider had offered extra refresher training and discussed medicine recording issues with staff to make them aware of their responsibilities.

Improvements had been made in how the provider sought consent to care and treatment in line with the Mental Capacity Act 2005 (MCA). Minor improvements were needed in how the provider assessed risks to people as there were inconsistences across the records we reviewed.

Although we found improvements had been made, the provider was still in the process of fully implementing all of their systems and processes. The provider regularly reminded staff to complete the appropriate records however we found that this was not always being done with people’s daily logs and medicines administration records. Not all of the records we requested were available as they had not been returned to the office.

The provider was aware of the challenges they faced and were committed to making the necessary improvements. They had started a pilot project which offered literacy support to staff where English was not their first language to help them carry out their responsibilities.

The provider continued to promote an open and honest culture and the majority of people and their relatives told us they were happy with the management of the service. Staff spoke positively about the support they received and the working environment.

We found a continuing breach of regulations in relation to safe care and treatment. You can see what action we told the provider to take at the end of the full version of this report.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement (report published 24 May 2018).

About the service: Care Solutions Bureau CIC is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection they were supporting 280 people in the London Borough of Tower Hamlets.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The previous inspection was a focused inspection on 21 and 22 March 2018 to check that improvements to meet legal requirements had been made. At this inspection, despite some continued improvements that had been made, we found that there were still inconsistencies across all the records we reviewed and improvements were still in the process of being fully implemented. Although improvements had been made in the Effective and Responsive key questions and were rated Good, the overall rating remained Requires Improvement. This is the fourth time this service has been rated Requires Improvement.

Follow up: We will ask the provider following this report being published to tell us how they will make changes to ensure they improve the rating of the service to at least Good. We will revisit the service in the future to check if improvements have been made.

No risks or concerns were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe and well led. At this inspection, we found that the provider had made a number of improvements however these were still in progress in relation to the records for all the people that used the service.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection they were supporting 240 people in the London Borough of Tower Hamlets. Not everyone using Care Solutions Bureau CIC receives a 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.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Despite some improvements being made, procedures were not always in place to ensure people received their medicines safely and effectively. Information about people’s medicines had been updated and care workers received refresher training and guidance in completing records accurately. However, not all records were being checked to ensure people received their medicines safely.

Improvements had been made to people’s risk assessments and there was evidence that people living with specific health conditions were assessed to ensure their safety and welfare. The provider was in the process of updating all of the records for people who used the service.

People told us that they felt safe using the service and staff were confident that any concerns would be investigated and dealt with. The provider had taken action since the last inspection to ensure staff followed policies and procedures.

The provider had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. People had regular care workers to ensure they received consistent levels of care.

People using the service and their relatives told us that the service was well managed and spoke positively about the level of care and support they received.

Improvements had been made and the provider was now meeting their legal obligations to inform the CQC of notifiable incidents. Statutory notifications had been received, recorded and followed up appropriately with the relevant health and social care professionals.

There was evidence of positive action being taken after the last inspection and staff spoke highly of the support they received to make the necessary improvements. Systems to monitor the quality of the service were in place however were still in the process of being fully implemented.

At the last inspection on 6 September 2016 we found breaches in relation to safe care and treatment, the employment of fit and proper persons and good governance. We made three recommendations in relation to staff training, care planning and the recording and monitoring of people’s medicines. The service was rated Requires Improvement overall. At this inspection, despite some improvements, we found that not all improvements had been made.

Care Solution Bureau CIC is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our previous inspection the service was providing support to eight people in the London Borough of Tower Hamlets, however only two people were receiving personal care. At this inspection they were supporting approximately 160 people who were all funded by the London Borough of Tower Hamlets. Since the last inspection, the provider had been successful in securing a contract with the local authority as an approved provider, which was the reason why the number of people the provider was supporting had increased dramatically within a relatively short period of time.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 who lived with specific health conditions did not always have the risks associated with these conditions assessed and care plans were not always developed from these to ensure their safety and welfare. Control measures in place for people’s nutritional assessments were not being followed. Risk assessments did not always provide staff with guidance on how to minimise risk.

The provider did not have appropriate policies and procedures in place to ensure that people received their medicines safely and effectively. People’s records were not always clear as to what support they received with their medicines and were not being checked to ensure they received them safely.

Care workers understood how to protect people from abuse and were confident that any concerns would be investigated and dealt with. Staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns, with regular reminders being sent out to care workers. However, the provider’s policies and procedures were not always followed.

The provider had improved their staff recruitment and initial interview assessment process to ensure staff were suitable to work with people using the service.

Staff did not have a clear understanding of the principles of the Mental Capacity Act 2005 (MCA). Where family members had signed to consent to the care and support of their family member, the provider was unable to demonstrate that the relative had the legal authority to do so and was therefore not working in line with the MCA.

A new training programme had been implemented since the last inspection and a system had been put in place to ensure it was refreshed on a regular basis. Staff received regular supervision and these were now being documented.

Care workers supported people to have a balanced diet and were aware of people’s dietary needs, but this information was not always recorded in people’s care plans. Care workers told us they notified the office if they had any concerns about people’s health and we saw records to show that it was followed up. We also saw people were supported to maintain their health and well-being through access to health and social care professionals.

People and their relatives told us care workers were kind and caring and knew how to provide the care and support they required. Care workers knew the people they supported and the provider had worked closely with both parties when care packages had been transferred.

Staff respected people’s privacy and dignity, respected their wishes and promoted their independence. There was evidence that language and cultural requirements were considered when carrying out the assessments and allocating care workers to people using the service.

The provider had taken on a large number of packages since the last inspection due to a local authority restructure and they were currently in the process of completing all their assessments and reviews for people who had been transferred over from other care agencies. Care plans were more person centred since the last inspection but there were inconsistencies in all the files we viewed. We were unable to review a number of people’s daily logs so we could not always be assured the care people received reflected their wishes.

People and their relatives knew how to make a complaint and were comfortable approaching staff if they needed to.

The provider did not meet the CQC registration requirements regarding the submission of notifications about serious incidents, for which they have a legal obligation to do so.

We could see that improvements had been made since the last inspection and the provider had made progress in documenting how they monitored the quality of the service. However, there was not an effective system in place to check the records of the care and treatment that people received, which was acknowledged by the provider.

The service promoted an open and honest culture and staff spoke positively about the warm and welcoming environment. Staff felt well supported by the director and registered manager and said that the transfer process had been managed well.

We made one recommendation in relation to consent.

We found a continuing breach of regulations in relation to safe care and treatment. There was also a breach of the regulations relating to notifiable incidents. You can see what action we told the provider to take at the end of the full version of this report.

Care Solution Bureau CIC is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing personal care and support to two people in the London Borough of Tower Hamlets. The provider supported six other people at the time of the inspection however none of them received personal care. The majority of people who used the service and the care workers who supported them used Somali to communicate with each other. All of the people using the service were funded by the local authority.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 who lived with specific health conditions did not always have the risks associated with these conditions assessed and care plans were not always developed from these to ensure their safety and welfare. Risk assessments lacked detail and did not always provide staff with guidance on how to minimise risk.

The provider did not have a robust staff recruitment process in place as the necessary checks to ensure staff were suitable to work with people using the service were not always carried out.

Care workers understood how to protect people from abuse and were confident that any concerns would be investigated and dealt with. Staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns. However, training was not refreshed on a regular basis.

The provider had a medicines policy in place where care workers were only allowed to prompt people’s medicines. Care workers knew what to do if they had any concerns however people’s medicines were not always recorded appropriately.

Care workers received an induction training programme to support them in meeting people’s needs effectively and were always introduced to people before starting work with them. They shadowed more experienced staff before they started to deliver personal care independently however not all staff received regular supervision from management and there was no system in place for training to be reviewed on a regular basis.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Care workers respected people’s decisions and gained people’s consent before they provided any care and support. However, the provider did not have any specific training on the MCA for staff to keep their knowledge up to date.

Care workers were aware of people’s dietary needs and food preferences but this information was not always recorded in people’s care plans. Care workers told us they notified the office if they had any concerns about people’s health and we saw records to show that it was followed up. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, occupational therapists and social services.

People and their relatives told us care workers were compassionate and caring and knew how to provide the care and support they required. Care workers understood the importance of getting to know the people they supported and showed concerns for people’s health and welfare.

Staff respected people’s privacy and dignity, respected their wishes and promoted their independence. There was evidence that language and cultural requirements were considered when carrying out the assessments and allocating care workers to people using the service.

People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and risk assessments were developed. However, care plans were not always person centred and lacked detail, not always complete and not reviewed on a regular basis.

People and their relatives knew how to make a complaint and were comfortable approaching staff if they needed to. There was an annual survey in place to allow people and their relatives the opportunity to feedback about the care and treatment they received. Information about the service was available in both English and Somali, and staff were able to explain this in people’s own language.

The service was family oriented and promoted an open and honest culture. Staff felt well supported by the director and registered manager and were confident they could raise any concerns or issues, knowing they would be listened to and acted on.

There were processes in place to monitor the quality of the service provided and understand the experiences of people who used the service. This was achieved through regular communication with people and care workers, supervision and regular home visits however they were not always documented.

The provider had an understanding of what incidents care workers needed to report to the office however they were not fully aware of all incidents that needed to be notified to the Care Quality Commission, which is a legal requirement of the provider’s registration.

We made three recommendations in relation to staff training, care planning and medicines records.

We identified three breaches of the Regulations in relation to safety, good governance and recruitment and you can see what action we told the provider to take at the end of the full version of this report.

Staff that we spoke with told us they felt supported and attended monthly supervision meetings with managers. We saw records that confirmed these meetings had taken place.

We also looked at staff training records and saw that the provider had arranged for staff to attend a number of courses since the previous inspection, including safeguarding, moving and handling and food hygiene amongst others. Staff that we spoke with were satisfied with the amount of training that they received and told us it helped them to carry out their role as care workers more effectively.

People told us the service met their individual needs. One person said, 'they are really good, I am happy with the care and we work together to make sure my relative is looked after.'

People we spoke with told us their relatives were satisfied with the service provided and the care workers always treated their family member with respect and kindness.

People liked the service because staff respected their cultural and religious practices. One person we spoke with said, 'the best thing is that they speak the same language and they can explain everything. They always take note of your wishes.'

The provider had one to one monthly meetings with care workers but there were no supervisory meetings for staff at management level. The staff training log for mandatory training courses was also unavailable at the time of our inspection. the provider was therefore not able to prove that care workers were adequately trained and supported to deliver care safely and to an appropriate standard.