Choices Healthcare Limited

Choices Healthcare Limited is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection there were 109 people using the service. There were also 3 people receiving support with personal care at Alphabet House in Tower Hamlets. This was a supported living service with 4 service users.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were not always supported by staff who had been recruited safely and they did not always receive consistent care in a timely way.

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.

Right Care:

People had detailed personalised care plans, but risk assessments were not always as thorough.

Systems to monitor the quality and safety of the service were not always effective.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to recognise and report any concerns.

People were supported by staff to pursue their interests.

Right Culture:

People were encouraged to share their views of the service.

People were cared for by staff who felt well supported by the rest of the team and managers.

The service and had built positive working relationships with other healthcare professionals to support people's needs and share learning.

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 good (27 May 2021)

Why we inspected

We inspected this service due to an increase in safeguarding concerns and complaints about the service. The supported living aspect of the service had not been inspected before.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Choices Healthcare Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to recruitment, staffing, infection prevention and control and governance at this inspection .

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Choices Healthcare Limited is a domiciliary care agency providing personal care to people in their own homes. At the time of inspection, the service was providing care to 79 people, with 68 people receiving personal care.

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

We found most people received care from a regular staff group who arrived at the expected time. The service had introduced a system to minimise the risk of missed calls and people told us staff always attended.

People and relatives told us they felt safe and confident with the staff. Staff had received training in adult safeguarding and were aware of the procedure to take if they had any concerns regarding allegation of abuse.

The service had a robust recruitment process in place and staff followed an induction programme. Staff received both online and practical training. Competency assessments were carried out during spot check visits by the registered manager and the quality assurance manager.

Staff had undertaken training in medicine administration. Staff rotas were arranged to make certain visits coincided when time-specific medicines were due, ensuring they were given as prescribed.

Staff followed infection prevention and control procedures in line with the government COVID-19 pandemic guidelines. Staff had training in donning and doffing of personal protective equipment (PPE) and told us they had a plentiful supply. People confirmed staff wore PPE and disposed of it correctly at the end of their visit.

Care plans were person-centred, and people told us they were involved in their planning of care. Risk assessments were completed and provided guidance for staff on how to mitigate risks. People told us staff were caring, respectful and promoted their independence.

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.

The service had a complaints policy in place and had improved the process of dealing with complaints since the last inspection. Information about raising a complaint was in the service user guide and people told us they knew how to raise a concern and were confident it would be dealt with appropriately. People and relatives told us communication with the service was good.

The service had a robust auditing system in place which was managed by the registered manager and quality assurance manager to ensure oversight of the service. Staff received supervisions and meetings. Staff told us the management team were approachable and supportive.

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 Requires Improvement (published 18 February 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to notifications and concerns received about moving and handling, infection control and missed calls. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe section of this full report.

The overall rating for the service has changed from Requires Improvement to Good. 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 Choices Healthcare Limited on our website at www.cqc.org.uk.

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.

Choices Healthcare Limited is registered to provide personal care to older people, people with learning disabilities and/or mental health and physical care needs in their own homes. At the time of our inspection, Choices Healthcare Ltd was supporting 104 people with personal care.

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

Information relating to people’s individual risks was not always recorded to provide guidance to staff on how to keep people safe. Suitable arrangements were not always in place to ensure the safe use of medicines. People were not always informed when staff were running late. The monitoring of missed and late calls was not robust. Lessons were not always learned to ensure that the quality and safety of the care improved. Required recruitment checks were not always complete to ensure staff were suitable to work with vulnerable people. People were protected by the prevention and control of infection.

Staff received some training but had not been trained to meet the specific needs of people in continence care, pressure care or diabetes management. Staff completed an induction and received supervision and spot checks of their practice. People were supported with their nutritional needs and received ongoing healthcare support. 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, however people’s capacity to make decisions in relation to medicines administration had not been assessed and recorded.

Though people using the service and their relatives said staff were caring and kind, our findings did not always suggest a consistently caring service. People were asked for their views on the service through reviews of their care and quality monitoring visits, however the action taken in response was not always documented to evidence improvement. People’s privacy and dignity was maintained, and their independence encouraged.

The management of concerns and complaints was disorganised and did not always address the concerns raised. People using the service and those acting on their behalf were not always confident that their concerns would be listened to, taken seriously and acted upon. Some care plans contained contradictory or limited information on how to support the person, however staff knew people well. Staff received training in death, dying and bereavement.

Although audits were completed on the care provided, these were not always effective in demonstrating that improvements had been made. The registered manager had not notified the commission of events that occurred within the service. Staff were positive about the registered manager and felt well supported.

We have made a recommendation the implementation of the Accessible Information Standard.

Rating at last inspection

The last rating for this service was Good (published 25 July 2017).

Why we inspected

This was a planned inspection.

Enforcement

We identified three breaches in relation to the managerial oversight of the service, staffing and the management of complaints.

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 from 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 and to check that improvements have been made. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

When we last inspected the service on the 23 and 24 January 2017 the outcome of the inspection was Good in all areas and we had no concerns.

Choices Healthcare Limited provides care services to people within their own homes. Care services include personal care, a sitting service and domestic services. The service provided are either through private arrangement or social services funding. The service covers Southend on Sea and Essex.

The service had a registered manager who was also the registered provider of the service. A registered manager is a person who has registered with the Care Quality Commission 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.

In April 2017 we received some concerns around the service recruiting staff aged between 16-18 and not having appropriate safety measures in place when they are lone working. We found the service to have appropriate measures in place in regards to safe recruitment and in light of the concerns that had been raised the registered manager reviewed the recruitment process as to ensure additional support was made available for staff aged between16-18.

We also reviewed records relating to an incident whereby care staff had left a person's home without turning off the cooker. The registered manager has cascaded a message to all staff reminding them that staff are not to prepare a meal using a cooker unless a risk assessment has been completed.

At the last inspection, the service was rated overall Requires Improvement as improvement needed to be made in the Safe and Well Led domains. At this inspection we found the service had made some improvement.

The service was safe. The service’s recruitment process ensured that appropriate checks were carried out before staff commenced employment. There were sufficient staff to meet the needs of people and keep them safe from potential harm or abuse. People’s health and wellbeing needs were assessed and reviewed to minimise risk to health. We found one record that needed to be addressed, the manager assured us this would be addressed immediately.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to health and social care services was made when required.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were supported to follow their interests and participate in social activities. The service responded to complaints received in a timely manner.

The service was well-led. Staff, people and their relatives applauded the manager and informed us they were supportive and worked hard to provide a good service. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis. The registered manager acknowledged that some of the systems and processes needed to be improved.

Choices Healthcare Limited provides care services to people within their own homes. Care services include personal care, a sitting service and domestic services. The service provided are either through private arrangement or social services funding. The service covers Southend on Sea and Essex.

The service has a registered manager. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

Medication practice required improvement to ensure that people received their medication as prescribed. The quality assurance system needed to be improved to ensure that it is effective in all areas of the service including medication management.

The manager had some systems in place to identify and monitor the safety and quality of the service however they had provided to be ineffective as they either did not recognise the shortfalls or when they did there was a lack of action to rectify them.

Suitable arrangements were in place to ensure that people received appropriate care and support to meet their needs. Staff knew the needs of the people they supported and they were treated with respect and dignity. People’s healthcare needs were well managed and they had access to a range of healthcare professionals.

People’s needs were met by sufficient numbers of staff. Suitable arrangements were in place to ensure that staff had been recruited safely; they received opportunities for training and supervision. People were safeguarded from harm; Staff had received training in Mental Capacity Act (MCA) 2005. People were supported to ensure they had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were being met was required.

People were provided with the opportunity to participate and engage in activities of their choice which met their needs. Relatives and people who used the service knew how to make a complaint and we felt reassured that all complaints would be dealt with and resolved efficiently and in a timely manner.

The service had a number of ways of gathering people’s views which included holding meetings with staff and carrying out annual service user surveys.

Due to the nature of the concern we did not speak with people using the service as they did not have involvement in the recruitment process. We spoke with three care staff about the recruitment process and induction. We found that appropriate checks were completed prior to new staff being employed.