Archived: 4USupport Limited

4USupport Limited is a domiciliary care agency providing personal care to people living in their own home. The service operates within a six-mile radius of the Plymouth area. At the time of the inspection 79 people were using the 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 staff were punctual and stayed for the allotted time. Since the previous inspection the registered manager had built travel time into staff rotas. This meant staff were able to spend the allotted time with people without it impacting on the following visit times. An electronic system had been established which enabled the registered manager to monitor visit times and highlight when people required longer or shorter visits.

People told us they felt safe when being supported by staff from 4USupport. When the service assessed people’s needs any risks to people’s health were highlighted and staff received guidance on how to support people to minimise those risks.

Staff received training to equip them with the skills and knowledge they needed to support people safely and in line with their preferences. Regular competency assessments were completed to help ensure staff continued to support people in line with their training.

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 worked collaboratively with other organisations, alerting relevant agencies when people were seen to need additional support. Communication between the office and staff had been identified as an area for improvement and action was being taken to address this.

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 (report published 9 November 2020).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 11 and 14 October 2019. Breaches of legal requirements were found. We carried out a focused inspection in October 2020 and found the provider remained in breach of the regulations. We issued a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve staff deployment and training.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 4USupport 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.

4 U Support is domiciliary care service providing personal care and support to people in the Plymouth area. There were 61 people receiving a service at the time of this inspection. 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 personal care is provided we also consider any wider social care provided.

There were two registered managers in post. A registered manager is a person who has registered with the CQC 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.

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

The Care Quality Commission (CQC) and the local authority had received concerns from people receiving care from this service prior to this inspection, regarding poor training of staff, poor culture, lack of equipment, visit times not as expected and not having their concerns responded to.

Some people told us their visits were not always as expected. Fifteen out of 28 people reported to us that they had experienced visits not as planned. People told us “When I ring the office and say I’m not happy because the call times have been changed again, they say 'Sorry, it won’t happen again'. But then it does happen again and again. It’s very frustrating to say the least.” Staff told us, “I have fed back concerns to the office. Nothing changes” and “We keep telling them, but it does not help.” Relatives told us, “I have emailed them repeatedly and got no response at all” and “This morning the carers were an hour late. I’ve rung the office to complain, but I don’t know if it’s been passed on, or who it may have been passed on to, or what they might do about it. It’s so frustrating because if I’d have known the call was going to be that late I’d have got (Person’s name) ready myself. It’s horrible for (Person’s name) being stuck in bed waiting for ages. This isn’t the first time it’s happened.”

Some relatives told us their family member did not always have their wishes respected when they had requested care staff of a specific gender. This was not always provided and led to people sending the male carers away and then trying to provide for the needs of others. This had impacted on the families, who lived with the person, who were often kept waiting for support.

The staff rota did not always provide adequate time for staff to travel from one person to another and arrive on time. Staff told us, “We get no travel time between visits, and so it is impossible for us to do the job properly and get to the next person when they expect us. If you do all that you are required to do you end up running late and working hours that you are not being paid for. I have told the office about this but nothing changes.”

The registered manager was aware of these concerns and had taken some action however, this had not been effective in resolving these issues and to bring about consistent improvements.

People told us staff mostly stayed for the agreed period of time for the visit when they arrived. However, we found the rota did not allow for staff to stay for the commissioned period of time and still arrive at the next visit as expected.

Staff told us the registered manager was not always available and they dealt with the office management team when necessary. Some staff reported good support from the office staff others told us there was 'animosity and chaos between the management team which impacted on the service.'

Due to the recent change in computer systems used at this service, the management team were not always able to provide information requested by CQC prior to this inspection. This was collated and provided the day after. This information showed the registered manager did not have effective oversight of staff training, supervision and appraisal, and staff had not completed training necessary for staff to carry out their role safely.

All the people we spoke with told us they received good care from the care staff who were kind and caring. Comments included, “I get very good care, the help that I get to get dressed is really good, they are all so caring, I have no problems with any of them.” Relatives told us, “On her birthday they bought my mother presents and cards. The younger girls call her Granny, she loves that” and “They are always very friendly and obliging, they interact with Mum, make her feel at ease. They address her by her first name, they are like a family friend”.

People’s support plans did inform, direct or guide staff in what actions to take to meet their needs in the way they chose.

People were not always supported to have maximum choice and control of their lives and staff did not always 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. For exampled, not respecting people's choice of gender of carer and not providing visits at the time agreed.

Systems had been implemented to help ensure the effective management of medicines. Some staff who were administering medication were provided with training and had their competencies checked to help ensure correct procedures were followed. However, not all staff had received training in medicines management.

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 21 November 2019).

At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about visits not made when expected, lack of necessary equipment, poor moving and handling practices, poor culture and poor responses from the management to concerns raised. A decision was made for us to inspect and examine those risks. As a result, we carried out a focused inspection to review the key questions of safe, effective and well-led only. We also reviewed the breaches of regulation from the last inspection.

We reviewed the information we held about the service. We requested additional information from the provider prior to the office visit. 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.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 4U Support 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.

4USupport Ltd is a domiciliary care agency providing personal care. The service is operated from an office in Plymouth. 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. Not everyone who used the service received personal care. The service was providing personal care to 85 people at the time of the inspection.

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

People did not always receive their calls at the time agreed, or for the length of time planned. People told us they did not always have support from a consistent staff team and sometimes felt rushed. They also told us that they were not always informed of staff changes and did not always feel issues they raised about the calls were resolved.

The registered manager had acted to improve the quality of the service since the last inspection. However, there was a lack of oversight of call times which meant identifying areas for improvement was difficult.

People told us they felt experienced staff were well trained and made them feel safe. Some people raised concerns about the knowledge of new staff. We have made a recommendation about this.

People received appropriate support with their medicines and health. People’s wishes relating to eating and drinking were known and respected. Risks relating to people’s care were known by staff but not all recorded in a clear risk assessment.

People were supported by staff to make decisions about their care. People were happy with the content of their care plans and told us their choices and preferences were reflected. There was a plan in place to ensure everyone’s care plans were reviewed. 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 felt well cared for by staff. One person told us, “Nothing’s too much trouble.” Feedback received by the service showed examples of staff going beyond the remit of their role to ensure people’s preferences were met.

New systems had been implemented to monitor the quality of the service and improvements had been made about most of the concerns identified as part of the last inspection.

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 18 October 2018) 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 some improvements had been made but the provider was still in breach of regulations. The service remains rated requires improvement.

Why we inspected This was a planned inspection based on the previous rating.

Enforcement We have identified breaches in relation to the way calls are planned, and the monitoring of the quality of the service.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager, who was also the registered provider. 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. The registered manager/provider was unavailable to attend this inspection and so we worked with their representatives. We received information from the registered manager following the inspection visits.

At the last comprehensive inspection in January 2016 the service was rated Good overall. At this inspection we found the evidence could no longer support that rating and now the overall rating is Requires Improvement.

Why the service now has the rating of Requires Improvement.

Staff recruitment was not robust because staff were employed before it was confirmed they were fit employees to work with vulnerable people. Staff did not work alone at this time, but were already getting to know people, including how to access their home.

Staffing arrangements did not ensure people received the amount of visit time they required, in accordance with their care plan. Some staff said they did not have the travel time they needed, and the registered manager said this would be increased. However, the registered manager did not expect staff to stay the full time agreed, in accordance with the person’s care plan.

Opinion about continuity of the care workers visiting varied widely. The provider representatives said they worked continually to improve visits, and care workers confirmed visits were never missed. An ‘app’ monitoring device meant the office was fully aware of the times care workers arrived at a person’s house and when they left. One person told us, “There used to be different carers every day, in the last 4-5 months its got much better.”

Some risks were assessed and action to protect people were in place, but not all risk management was clear, such as who was at risk from cleaning chemicals in a person’s home. There was no evidence that this had led to a poor outcome for people but we have recommended that risk assessment is reviewed.

People told us they felt safe when receiving care and support. They said care workers were skilled and competent when assisting them, and this is what we observed.

People said they received their medicines on time and as expected and care workers said they were clear in how to provide medicines safely. However, the information about medicine assistance in people’s care plans was not always clear or complete, and this was not being checked by team leaders. This was corrected following our feedback. Care workers were very clear on how to report any medicine errors and few errors had occurred.

Care workers confirmed they had all the necessary protective clothing to promote hygiene and infection control. The use of protective clothing was monitored by senior agency staff.

People were protected through the agency’s safeguarding arrangements. Staff knew what action to take if they suspected someone was being abused, mistreated or neglected. Where care workers handled people’s money there were checks in place to ensure this was done in a safe way. There were arrangements for reporting accidents and incidents. There had been very few.

Staff spoke positively about the training they received and people said the care workers were skilled. Staff received supervision of their work although this was a few weeks behind the agency’s schedule. Staff said the Care Certificate training looked at and discussed the Equality and Diversity policy of the company.

People were enabled and supported to lead fulfilling, independent and active lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. One person said, “The carers respect that (the person) likes to do things for himself.”

Health care concerns were identified and promptly followed up. Care workers worked in cooperation with health care professionals where people’s needs were complex.

People’s equality and diversity was respected and people were supported in the way they wanted to be. People's human rights were protected because the staff had an understanding of the Mental Capacity Act 2005 (MCA) and the importance of people consenting to their care.

People and their family members said that care workers were kind and caring. Some strong friendly relationships had been formed. People confirmed they were treated with respect and their dignity and privacy were upheld. Care workers always sought people’s views and tried to accommodate them. Where people found it difficult to communicate or express themselves, care workers offered additional support and showed patience and understanding.

People’s needs were fully assessed prior to receiving a service and their care was planned with their agreement. People received person centred care. However, more information about people’s background would help care workers further improve this.

People said they were confident any complaint would be handled appropriately and complaints had been investigated and thoroughly followed up. There were plans to further improve this.

People received a service where the provider’s values were embedded into the leadership and culture. Staff told us the registered manager was approachable and made themselves available for support and guidance.

Some people and staff mentioned difficulties communicating with the office but there were arrangements in place for senior staff to be contactable at any time and these were improved following the provider’s quality monitoring survey results. People had agency contact details in their home.

Systems for monitoring the quality of the service were in place and in use. There was a clear emphasis on looking for ways to continually improve the service. However, the provider had not taken into account how their recruitment and staffing practice put people using the service at risk.

There was a clear organisational structure in place.

We found three breaches of Regulations in 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.

After that inspection we received concerns in relation to shortages of staff, staff missing appointments and cancelling visits at short notice due to shortages of staff.

The concerns went on to say that staff were not being recruited safely and there were no risk assessments in place for people to help protect them and the staff providing care. Concerns suggested that manual handling risk assessments showed that two staff members where needed to move people safely but only one staff member had been sent and that one person’s equipment was not suitable to keep them safe. Also, it was alleged that there were no risk assessments to show staff what care was needed for people they visited for the first time including environmental risk assessment and any behavioural issues with people living with a mental illness.

It was also alleged that staff where not provided with suitable identification to show people when they visited for the first time. The concerns received also stated that people’s medicines where not always managed appropriately and safely. For example people did not have recording sheets, MAR (Medicine Administration Records) for staff to complete after they had administered medicines to people, no list of what medicines people where prescribed and that staff had not always received medicines training to help keep people safe. Other information about medicines stated that people prescribed and receiving eye drops did not have a date recorded on when these had been opened or a “to be used by” date.

Another concern raised was that staff did not leave people’s houses hygienically clean and that staff where not being informed of infection control issues when they visited people’s houses. For example if people had an infectious skin condition.

There were concerns raised that people did not have expenditure forms for any money they were asked to use to purchase items with and nowhere to record receipts of items purchased.

Though there was a lone working policy in place the concerns raised stated that staff did not always have on call advice made available to them particularly when the registered manager was on holiday.

As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 4USupport Limited on our website at www.cqc.org.uk.

4USupport Limited is registered to provide personal care service to people living in their own home. On the day of the inspection 4USupport were providing care to over 100 people.

The service had a registered manager in post. 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’. The registered manager is also the registered provider. 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.

People’s needs were met by sufficient numbers of staff. Rotas recorded there were sufficient staff employed to provide two staff when required. Staff were knowledgeable about people's needs and received training, for example manual handling training, to help keep people safe. One person said of the agency; “Absolutely marvellous!”

The registered manager followed safe recruitment practices to help ensure staff were suitable to work with vulnerable adults. Staff received identification badges to provide people receiving a service reassurance and the security of knowing staff worked for this agency when entering their home.

People’s care records held information about how people wished to be supported and what level of support was required to help keep them safe.

People’s individual risks were documented, monitored and managed well to ensure they remained safe. The agency had policies and procedures in place which were understood by staff to help protect people and keep them safe.

People’s medicines were managed safely. People had a list of medicines prescribed held on file. Records recorded any health care needs or input by health care professionals, for example district nurses.

At this inspection we found the service Good in SAFE.

4uSupport DCA provides a personal care service to people living in their own home. On the day of the inspection 58 people were being supported by 4uSupport with their personal care needs.

The service had a registered manager in post. 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.

People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable adults. There were sufficient numbers of staff employed to support people safely. Staff received an induction programme. Staff had completed training and had the right skills and knowledge to meet people’s needs. Staff described the management as very open, supportive and approachable. Staff talked positively about their jobs and felt motivated to provide quality care.

Care records contained information that described what staff needed to do to provide individual care and support at each visit. Staff responded quickly to people’s change in needs. Where appropriate, friends, relatives and health and social care professionals were involved in identifying and supporting people’s needs. People’s preferences, disabilities and abilities were taken into account, communicated and recorded.

People’s risks were managed well and monitored. The service had policies and procedures in place and these were understood by staff to help protect people and keep them safe.

People who required it were encouraged and supported to maintain a healthy balanced diet.

People’s medicines were managed safely and people and staff told us people received their medicines as prescribed.

People, their relatives and staff were encouraged to be involved and help drive continuous improvements. This helped ensure positive progress was made in the delivery of care and support provided by the service.

The service sought verbal feedback from people, relatives, and staff. People were encouraged to share their concerns and complaints. The registered manager investigated any complaints or concerns thoroughly and used the outcome as an opportunity for learning to take place.

The registered manager and staff had completed training in the Mental Capacity Act. The registered manager displayed a good understanding of the requirements of the act, which had been followed in practice.

People were kept safe and protected from discrimination. All staff had undertaken training on safeguarding from abuse and equality and diversity. Staff understood the principles, had a good knowledge on how to report any concerns and described what action they would take to protect people against harm.

There were effective quality assurance systems in place to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.