Phemacare Ltd

Updated 13 July 2021

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 an inspector and an assistant 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 prior notice of the inspection. This was because it is a small service and we wanted to be sure that the provider or registered manager would be in the office to support the inspection.

However, neither the registered manager nor the provider were available on the day of the inspection, although the registered manager told us they would be visiting the location later that day, they did not.

What we did before the inspection

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 reviewed information we had received about the service since they registered with CQC. We sought feedback from the local authority who work with the service.

This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We requested documentation prior to the inspection taking place, this was not provided as requested.

We experienced some difficulty in carrying out the inspection due to some staff and care records not being available at the location for us to review. Also records at the location were not always stored in a way so they could be easily identified, making it difficult for information to be made available on the day.

We spoke with six people who used the service and four relatives about their experience of the care provided. We spoke with eight members of staff including the operations manager, senior care worker and care workers.

We reviewed a range of records. This included eight people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including audits were reviewed.

After the inspection

We continued to seek clarification from the provider, service users and care staff to validate evidence found. We looked at training data, medication administration records, care plans and call records.

Updated 13 July 2021

About the service

Phemacare Ltd is a is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 51 people from the location, with personal care in their own homes at the time of our inspection.

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

We were hindered in carrying out this inspection due to records not being available when requested whilst at the location. This was due to documents and files being removed from the location and the lack of organisation of stored documents. This was also identified at the previous inspection.

There continued to be a lack of provider oversight which meant risks to people’s safety had not been responded to appropriately. Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm. The systems in place had failed to identify the areas for improvement found at this inspection including the safe administration of medication and care planning.

Care plans were not in place for known health conditions for all people, to enable staff to have the information they needed to mitigate risk and meet or respond to their needs.

People we spoke to said they felt safe , and individual staff were kind and caring.

Staff we spoke to told us they had received some training to meet people’s needs. However, we saw from records that staff still had not completed training on all of the health conditions of people using the service, to give them the knowledge and skills to support them safely. This was identified at the last inspection.

Medication administration records (MAR) did not always include the current list of medications prescribed for people using the service. This meant care staff did not have accurate records to refer to, ensuring they were giving the correct medication at the correct time.

Spot checks of staff visits in people’s homes were completed to monitor that people received the support they needed.

Audits need to be improved to provide clear and robust information and evidence of outcomes for people.

Systems and process which were in place were not robust to protect people from potential harm.

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 previously inspected 12 November 2020 and it was rated as requires improvement.

Why we inspected

We carried out an announced inspection of this service on 24 March and 08 April 2021. Breaches of legal requirements were found.

The provider was issued with Warning Notices for breaches identified at the last inspection in relation to Regulation 12 Safe care and treatment, Regulation 17 Good governance Social Care Act 2008 (Regulated Activities) Regulations 2014. The Provider had completed an action plan to show what they would do and by when to improve. During the inspection we found evidence that the action plans had not been met.

We undertook this responsive inspection to check the provider had followed their action plan and to confirm they now met legal requirements.

You can read the report from our last focussed inspection, by selecting the ‘all reports’ link for Phemacare Ltd on our website at www.cqc.org.uk.

You can see what action we have asked the provider to take at the end 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 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 the safe care and treatment of people using the service, good governance and safe recruitment process at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.