About the service Care Solutions Fylde Limited is a is a domiciliary care service providing personal care to 31 people at the time of the inspection. 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
The provider had identified risks to people’s health and wellbeing, but some care plans failed to have strategies and guidance to support staff to manage these risks. Medicines management and administration were not consistently reviewed allowing poor practice not to be identified and addressed. Quality assurance activities were not consistently completed or effective. They had not identified the shortfalls we found during our inspection.
Not all documentation supporting safe recruitment was in place. We have made a recommendation about this. People recognised the service was improving but feedback consistently complained about poor timekeeping. We have made a recommendation about this. People gave mixed feedback on person centred care. We have made a recommendation about this.
We received conflicting feedback on personal protective equipment. Some people and one relative stated not all staff wore uniforms or wore PPE. However, the management team and staff said PPE was available and accessible. The provider liaised with the local authority, sharing information on the current pandemic status. All staff participated in weekly testing and had received guidance on how to access the Covid-19 vaccination.
The pandemic had impacted on training, but electronic training was ongoing, and staff told us they had the skills to meet people’s needs. Staff told us they felt supported by the management team. 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. Consenting to care was included within people’s care plan. Feedback on staff being caring and respectful was positive. Comments included, “They are respectful of my dignity.” And, “They are very friendly, helpful and respectful.”
Not everyone had up to date care plans, however people felt the care they received was improving. The management team were in the process of reviewing documentation. Visit times and the duration of staff visits were under review. There were processes in place to respond to complaints or concerns. Not all these were shared as part of the inspection. No one was being supported with end of life care. There was no process in place to discuss people’s preferred priorities of care and end of life.
The service did not have a manager registered with the Care Quality Commission as required by law at the time of our inspection. The provider had appointed a new manager. People, staff and relatives were involved in the service. Staff and management worked in partnership with other agencies, social and health professionals and external organisations.
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 21/04/2020 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about the management of risk, the support people received, governance and leadership. A decision was made for us to inspect and examine those risks. We looked at infection prevention and control measures under the Safe key question. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
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 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 and Governance. The provider did not manage risk or medicines consistently safely. The did not use quality assurance processes to identify and address concerns in a timely manner.
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.