Archived: 1st React Healthcare - 1st React Healthcare Domicilary Care Agency

1st React Healthcare – 1st React Healthcare Domiciliary Agency is a domiciliary care agency based in Exmouth. The service provides personal care to adults in their own homes. 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 service was supporting 59 people with personal care.

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

Robust systems were not in place to ensure staff attended calls in a timely way for the commissioned length of time. People and relatives all told us they did not know which staff were visiting and when. They told us staff did not always stay for the correct amount of time and this was confirmed by daily records. Daily notes often stated that people did not want anything else doing when there was a short visit, but people and relatives told us the staff voiced to them they were busy and short staffed and so were reluctant to ask them to stay. This meant that tasks were sometimes not completed despite specific health conditions and care plan instructions and staff did not have time to talk to people.

All staff, people and relatives spoken to voiced concerns about missed visits and the difficulty in contacting the service. The registered manager said there was not an issue with missed visits, but this was a theme in each person’s feedback to us. We saw messages sent to the office by one relative in July, September and October 2022 not being answered in a timely way asking where the carer was for their husband. This person should have had a morning visit for support with washing and dressing, but their December schedule had visits booked between 10.30 and 14.00.

Robust risk assessments were not in place in relation to people's health conditions and security to ensure they received safe care at all times.

Medicines were not being managed safely as people did not always have Medicines Administration Record when staff were supporting with medicines. People’s records did not always have a list of the medicines they were taking.

Pre-admission assessments and care plans did not involve people to ensure people's preferences with support and care were captured. The service did not carry out their own assessments prior to accepting care packages but waited for local authority assessments.

Care plans lacked evidence that people were being involved in decisions about their care. Staff said they did not always know what people needed when they visited them, and people did not see regular staff. One person had 12 different staff in a 7-day period.

Robust quality assurance systems were not in place to identify shortfalls and take prompt action to ensure people received safe and effective care at all times. The core issue of a lack of staff to cover the care package hours, poor scheduling and people not receiving allocated times they preferred had not been addressed.

Staff did not feel supported in their roles and told us they were unable to deliver the support people required.

People had choices during mealtimes, but people spoke of missed visits meaning they had no meal.

People were supported to access healthcare services, but short-term conditions such as pressure sores or chest infections were not monitored within records to ensure timely referrals or monitoring.

People were not always given the time commissioned to be encouraged to be independent and to carry out tasks without support.

Pre-employment checks had been carried out to ensure staff were suitable to support people.

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, published 14 September 2021.

Why we inspected

We had received concerns from staff, ex staff and relatives and a whole service safeguarding process was in place. Therefore, we wanted to visit people to see what their experience of the service was.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, training, person centred care and good governance. 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 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.

Special Measures

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 six 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.

1st React Healthcare is a domiciliary care agency providing personal care to people living in their own homes in Exmouth and surrounding areas. There were approximately 75 people receiving a service. 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

People told us they were happy with the care they received. The registered manager oversaw a good quality service which was safe, effective and well led.

There were enough staff in place to meet people's needs. People told us they were supported by consistent staff as much as possible, who understood their needs well.

Staff received appropriate training and support in their role. They treated people with dignity and respect.

People were safeguarded against the risks of suffering abuse and avoidable harm. Risks associated with people's care were assessed and effectively reduced.

People received care that identified positive outcomes and how these could be met. People were involved in planning and reviewing their care.

Care plans reflected people's needs, including the support they needed with their healthcare, medicines, nutrition and personal care.

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

There were systems in place to deal appropriately with complaints and feedback. The provider had effective systems in place to monitor the quality and safety of the service.

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 (published 22 February 2018).

Why we inspected

We received concerns in relation to timely visits and consistent staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. The overall rating for the service remains Good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

We previously inspected the service on 27 and 28 July 2016. At that inspection the service was rated requires improvement overall as the safe, effective, responsive and well led domains were rated requires improvement. The caring domain was rated as good. Three breaches of regulations were identified at the previous inspection related to medicines management, person centred care, and good governance. The service sent us an action plan to show how they would improve in these areas.

At this inspection, we found improvements in medicines management, person centred care, and in quality monitoring.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicine systems had improved so people received their medicines safely and on time. All staff had regular competency assessments to check their medicines management skills and knowledge. People felt safe using the service and said it was reliable. Regular care staff visited them who they got to know and trust. Concerns were identified about staff rotas with overlaps in people's visit times which meant staff couldn't be on time for some visits. We have made a recommendation about improvements needed in this area.

Staff knew about the signs of abuse, how to report concerns and their responsibilities to protect people. The service had not notified the Care Quality Commission (CQC) about three concerns about suspected abuse, although these had been appropriately dealt with the local authority safeguarding team. A notification is information about important events which the service is required to send us by law. The registered manager and provider are now aware of their responsibilities and have since sent us retrospective notifications. Staff were aware of risks and people’s risk assessments identified steps staff needed to take to promote people’s safety and welfare. Recruitment processes ensured people were cared for by suitable staff.

Staff had the skills and training needed to carry out their role and undertook regular training relevant to needs of people they cared for. People confirmed staff sought their consent before providing any care. Where people lacked capacity, staff demonstrated a good understanding of the Mental Capacity Act (MCA) (2005) and how this applied to their practice.

Staff developed positive and caring relationships with people. Care staff were motivated, people mattered and staff spoke with kindness and compassion about the people they supported. People confirmed staff respected their privacy and treated them with dignity and respect.

People's care was individualised to their needs. Staff enabled people to remain as independent as possible. People's care plans had improved, were more personalised, detailed and comprehensive and described positive ways in which staff could support them. People knew how to raise any concerns or complaints and felt confident to do so and action was taken in response to make improvements.

The culture of the service was open; people, relatives, professionals and staff were positive about leadership at the agency. Care and office staff worked well together as a team. The provider and registered manager worked well together, promoted good standards of care and developed the staff team. The service had a range of quality monitoring systems which included spot checks, regular review meetings, audits and surveys. They made continuous improvements in response to their findings.

1st React Healthcare Domiciliary Care Agency is a small domiciliary care agency registered to provide personal care to people living in their own homes. The agency provides care to people living in Exmouth and the surrounding areas. The service is managed from an office in Exmouth which is easily accessible for people, relatives and care staff. The length of time of visits was variable and depended upon the needs of the person. For example one person received a 15 minute visit to support them with medicine administration whilst others received visits of one hour. The agency also provided some sleep in cover to support people in their own homes. The frequency of visits ranged from one visit a week to four visits a day. At the time of inspection, the agency was providing personal care to approximately 43 people and employed 29 care staff.

There was not a registered manager in post at the service. 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 of the Health and Social Care Act and associated regulations about how the service is run. The provider has a condition on their registration to have a registered manager in post. They have submitted an application to CQC to have this condition removed. This was because the agency has only a single location and the provider managed the service herself. The provider was supported by an assistant manager and a deputy manager. Following the inspection the provider made us aware that they had withdrawn their application to remove the condition of having a registered manager in post. They confirmed an application was being submitted for a new registered manager .

People and their relatives felt safe, cared for and supported by care staff in their own homes. They were treated with kindness and respect. However some people were not happy as they did not have consistent care staff especially during holiday periods. Where there were missed visits the provider took action to try and prevent the risk of this happening again. They informed people of changes by telephone calls and schedules being issued .

Staff were recruited safely. They undertook an induction and received training and worked with experienced care staff doing shadow shifts. However once new care staff had completed their induction they were not monitored and assessed to ensure they were delivering good care until they had their six monthly supervision and annual appraisals. Following the inspection the provider made us aware that they had made changes to improve staff monitoring and competency observations.

At their supervisions and appraisals staff had the opportunity to discuss concerns and any further training needs. Staff felt supported in their work. Staff meetings took place and staff felt communication was good at the service.

People’s medicines were not managed in a safe and appropriate way. Improvements were required in how medicines were recorded to guide care staff to safely administer them. Care staff had not had their competence assessed to demonstrate they could administer medicines safely, which is good practice.

People had an assessment carried out when they started using the service. Care plans did not give care staff clear guidance about how to meet people’s needs. Care staff relied on relatives, people and other care staff who shared verbally information between them to gain knowledge about people’s needs. Staff were not always accurately completing people’s contact sheets. The provider said they would take action to improve their record keeping .

People were supported to eat and drink by care staff who knew what their food preferences were. However care staff had not always informed the management team of concerns when one person was taking a poor diet. The management team consulted health and social care professionals when needed.

Care staff asked for people’s consent before they gave any care. They had an awareness of the Mental Capacity Act (2005) and knew when to report any changes.

People knew who to contact if they had a problem or complaint. Concerns were taken seriously and investigated.

The provider actively sought the views of people, staff and relatives to develop the service.

The service audits to monitor and continually improve the service had not been completed effectively. The shortfalls we found in care plans and medicine records had not been identified.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Following the inspection the provider wrote to us and, in a detailed action plan, described the arrangements that would be put in to place to achieve compliance. We visited the agency and we found that the provider had made all the necessary improvements to become compliant within this area.

People who used the service and their relatives told us they were very happy with the care they received. They said 'the carers are marvellous'. When we spoke with care workers it was evident they knew people well.

People were properly safeguarded from abuse as care workers were clear on the procedures to follow if they had any concerns. The provider's had a safeguarding policy which contained the right procedure for care workers to follow when allegations of abuse were made.

Care workers had not received up to date supervision or appraisals. This meant that care workers did not have opportunity to discuss personal development or issues such as training and development on an indivividual or confidential basis

There were systems in place to monitor and improve the quality of the service provided. Everyone we spoke with told us there was nothing to complain about. We found records were kept in a way that protected people's safety and welfare.

We were told that a service was provided to approximately 56 people and approximately 20 staff were employed.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Records showed that each person had their needs assessed prior to receiving a service. In addition records showed that risks to people's health and welfare had been identified and that plans to manage these risks were in place and were recorded in people's care plans.

Staff told us they felt they had enough time and information that enabled them to meet people's needs effectively. People we spoke with told us that they felt safe while care was being delivered. People knew that the care files they had contained contact numbers if they had concerns or complaints.

Records showed that checks on the good character of individuals had been undertaken. For example, all three files contained two written references, records of checks with the Criminal Records Bureau (CRB) and copies of documents which provided proof of identity.

We found that systems designed to enable the provider to assess and monitor the quality of the services were in place. We saw that confidential records were kept within locked cabinets for security. We saw that all computers were password protected.