Passionate About Care

Passionate About Care is a domiciliary care agency providing personal care to people in their own homes. The service covers three main geographical areas: Petersfield, Havant and Waterlooville. The service was supporting older people, those living with dementia, people with a physical disability and younger adults.

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. 70 people were supported with personal care at the time of the inspection.

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

The governance systems in place were not always robust and fully established to support the management team to identify and address shortfalls or to drive improvement in all areas.

Risks associated with people’s support needs and health conditions had not always been effectively assessed, monitored or mitigated. This increased the risk of harm to people. The registered manager told us of their plans to improve the management of risk.

Staff were not always effectively deployed which meant there was a risk this would have a negative impact on people’s health and well-being. The provider began making improvements at the time of our inspection to improve this for people.

Complaints and concerns had not always been used to improve the service.

Staff had received training in safeguarding and knew the actions to take to keep people safe. Overall, people's medicines were managed safely. The provider had infection control policies and procedures in place to guide staff on how to reduce the risk of infections.

Staff felt well supported through training and supervision. Staff in the service worked well with each other and external professionals to ensure good health outcomes for people.

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.

People told us they were supported by kind and caring staff who treated them with dignity and respect. However, we have made a recommendation, so people are always supported in a person-centred way.

The provider had improved governance systems since our previous inspection and had introduced new auditing systems. This had led to many improvements. However, systems and processes needed to be embedded to ensure all regulations were complied with. Staff spoke positively about leaders at the service.

The nominated individual, registered manager and director demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support. Following the inspection, they sent us an action plan. Further progress was still needed to fully embed and sustain these improvements.

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 (report published 18 October 2021). There were seven breaches of regulation in relation to regulation 17 Good Governance, regulation 12 Safe Care and Treatment, regulation 11 Consent, regulation 18 Staffing, regulation 19 Recruitment, regulation 13 Safeguarding and Regulation 9 Person-centred care.

We imposed conditions on the providers registration, and they completed an action plan after the last inspection to show what they would do and by when to improve. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Passionate About Care on our website at www.cqc.org.uk.

At this inspection improvement had been made in some areas and the provider was no longer in breach of regulation 9, 11, 13 and 19. However, not enough improvement had been made in other areas and the provider was still in breach of regulation 12 and 17 and 18. We also identified an additional breach of regulation 16 Complaints.

Why we inspected

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

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe, Caring, Responsive and Well led 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 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, complaints and governance.

The provider has conditions on their registration which remain relevant to the findings at this inspection. We will request an updated action plan and meet with the provider.

Follow up

This service has been in Special Measures since September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

However, because improvement is still necessary, 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.

Havant & Petersfield is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 88 people at the time of the inspection, including older people, those living with dementia, people with a physical disability and younger adults.

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. 60 people were supported with personal care at the time of the inspection.

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

Medicines were not managed safely. There was a lack of oversight of medicine administration and medicine records were not always complete. We were not assured people always received their medicines as prescribed.

Risks to people's health and wellbeing had not always been assessed, monitored or mitigated effectively. People were at risk of harm because staff did not always have the information they needed to support people safely.

The provider had not established an effective system to ensure people were protected from the risk of abuse. Accidents and incidents were not appropriately reported, and actions were not always taken to ensure the safety of people.

Staff were not recruited safely. This meant people were potentially at risk of staff being employed to work with them who were not suitable. Staff were not always appropriately deployed to ensure people received support in a timely way that met their needs and preferences. Staff had not received all the training required to support people using the service and people and their relatives provided a mixed view regarding the skills of staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People did not always receive person centred care. A care plan was not in place when one person required end of life care. This meant staff did not have information about how best to support them at this time in their preferred way. There was a lack of understanding about the Accessible Information Act and improvements were needed to ensure people were supported with their communication needs effectively. Not all people were supported to receive their care visits at a time they preferred.

Improvements were needed with the management of complaints. We have made a recommendation about this.

The service was not well led. The provider did not have enough oversight of the service to ensure that it was being managed safely and that quality was maintained. Quality assurance processes had not identified concerns or driven sufficient improvement relating to service quality. Records were not always complete. The lack of robust quality assurance meant people were at risk of receiving poor quality care.

Most people and relatives were positive about the caring nature of the staff who supported them and felt they were treated with respect and dignity by them.

Following the inspection, the provider acknowledged the concerns that we identified during the inspection and told us of their plans to make improvements.

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 10 January 2020). There was one breach of regulation in relation to the provider not notifying CQC of incidents they were required to do so. The provider sent us an action plan to show what they would do and by when to improve.

Since this rating was awarded, the provider has altered its legal entity. The service has changed its location name from Passionate About to Care to Havant & Petersfield. It has also changed the location of the premises. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about call times, training, infection control and the management of complaints. A decision was made for us to inspect and examine those risks. The inspection was additionally carried out based on the date the provider altered its legal entity.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well-led sections of the full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Passionate About Care 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 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 medicines management, risk management, safeguarding, consent, governance, person centred care and staffing.

Follow up

We have imposed a condition on the providers registration which requires them to submit a monthly report to the Care Quality Commission on the actions being taken to ensure improvements are being made to quality and safety of the service.

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.

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.