RA Care Services Limited

About the service

RA Care Services Ltd is a domiciliary care service providing personal care to adults. At the time of this inspection 1 person was receiving a personal care 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 the service and what we found:

Right 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. People were encouraged to make choices and decisions in relation to the care they received.

People’s risks were assessed in a person-centred way. Care plans and risk assessments were regularly reviewed and involved relatives as appropriate. People were protected from the risks associated with the spread of infection.

Right Care

People’s needs were assessed before they began to use the service to ensure the provider could meet those needs. People had personalised care and support plans which included physical and mental health needs. Care plans documented people’s communication, cultural and spiritual needs. Where appropriate, people were supported with activities of their choice and to engage with their community.

A relative confirmed they were included in decision making about their relative’s care. People were supported to eat and drink enough to maintain a balanced diet. Staff supported people to maintain their health and worked jointly with healthcare professionals to improve outcomes for people.

Right Culture

Management were available for relatives and staff to make contact with at any time. A relative and staff confirmed they would be able to raise concerns to enable improvements to be made to the service. Relatives were asked by the provider about their opinions of the service.

Staff were recruited safely and there were enough staff on duty to meet people’s needs. People were protected from abuse and poor care. The provider supported staff with training and supervision. Training included learning disability and autism so care could be provided effectively.

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 3 November 2018).

At the last inspection, we made a recommendation in relation to ensuring consent was obtained in line with the Mental Capacity Act 2005 (MCA). At this inspection we found the provider had acted on this and had made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service. The provider had relocated and we received concerns about record keeping and staff training. A decision was made for us to inspect and examine those risks.

Follow Up

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

RA Care Services Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of our inspection the service was providing care to four people. At our last comprehensive inspection in March 2017 we rated this service ‘requires improvement’. We changed this rating to ‘good’ following a focussed inspection in December 2017. At this inspection we found the service remains ‘good.’

The service had a registered manager, who was the managing director of the company. 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 provider had recently appointed a new manager who intended to take over as the registered manager.

Care workers received suitable training when they joined the service as part of a recognised induction programme, but it wasn’t clear how often training needed to be repeated. We found that supervision and checks of staff capacity had been taking place consistently in the past few months.

There were detailed assessments carried out of people’s care needs and daily living skills, including those relating to the support people required to maintain their personal care, eating and drinking. These were used to devise care plans which met people’s needs, but there was considerable repetition in these plans. At times consent to care was obtained from people’s relatives rather than the person, and assessments of capacity were not decision specific. We have made a recommendation about how the provider obtains consent to care.

The provider operated systems for assessing risk and had plans in place for ensuring people received safe support. People’s living environments were assessed for safety and measures were in place to prevent the spread of infection. People told us their care workers arrived on time and stayed for the required duration. People were not receiving support with their medicines at this time.

There were measures in place to ensure care workers were suitable to carry out their roles, but we saw one instance where the correct previous job reference had not been obtained for a care worker. We have made a recommendation that the provider amend their recruitment processes to prevent this occurring in future.

The service gathered detailed information on how people’s cultural and religious needs were met, and their preferences for their care. Reviews and quality assurance checks were used to obtain peoples’ views about their care. Managers had audit systems in place for monitoring the quality of the service and documentation.

People using the service were not English speakers and told us they benefitted from receiving care from staff who could speak their language. People told us that care workers understood their needs and treated them with respect.

The team inspected the service against two of the five questions we ask about services: is the service responsive, is the service well led? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our inspection there were two people using the service. Not everyone using R.A. Care Services receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had a registered manager, who was the managing director of the company. 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.

At the last inspection, we had found a breach of regulation regarding person centred care. This was because care plans did not always contain sufficient information in order to meet people’s needs and some issues of concern were not followed up. At this inspection we found the provider was meeting this regulation. We found that care plans were now of a greatly improved standard and contained detailed personalised information on how people liked and needed to be supported.

Care workers maintained suitable logs of the care people received and these were checked by managers. There was a suitable complaints policy and system for recording and addressing complaints should they be received.

The registered manager had clear systems in place to ensure that records of care were of a good standard and that people were satisfied with the care they received. There was a clear strategy for overseeing the improvement of the service, including through the use of audits and communications with care workers.

Both people using the service were not English speakers and benefitted from having care workers who spoke their language.

Our last comprehensive inspection took place on 12 and 14 October 2016 and we found continuous breaches of regulations in relation to safe care and treatment, fit and proper persons employed, consent, staffing, person centred care and good governance. The service was rated inadequate overall and remained in ‘special measures’. Following this the provider sent us an action plan telling us how they were going to make improvements to the service. During this inspection we found that the provider had made improvements to the service, but some further actions were required.

RA Care Services Limited provides personal care and support for people living in their own homes. People used direct payments to purchase their care, which meant they had chosen to buy services from the provider. At the time of the inspection there were four people using the service.

The service had 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.

Risks to people’s care and support needs had been assessed and records contained detailed information on how to manage the risks associated with people’s care. Staff understood their responsibilities of safeguarding people from abuse, but could not describe how they would recognise the different types of abuse.

Although people did not require support with their medicines, staff had received medicines training and people’s medicines were recorded in their care plans. However, the provider did not follow best practice guidance in relation to the use of topical creams.

Staff told us they received appropriate training and attended supervision meetings to enhance and develop their skills.

People were supported to access health professionals and made their own choices about their dietary requirements. They were happy with the care they received and told us they felt listened to by staff who met their diverse needs.

People’s consent to care was assessed before they received a service in accordance with the Mental Capacity Act 2005 (MCA).

Care plans contained good background information in relation to people’s preferences, care needs and lifestyle choices, however further guidance was required to ensure staff supported people appropriately with their individual needs. People using the service and their relatives had no complaints about the service. Processes were in place to monitor and respond to any concerns, but the complaints policy required updating.

People and their relatives spoke positively about the provider and questionnaires had been sent to people to obtain their feedback to improve the way the provider delivered their service. Audits were carried out to monitor the quality of care however they did not identify the shortfalls we found.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We have made three recommendations relating to medicines, fit and proper persons employed and good governance. We found one breach of regulation relating to person centred care. You can see what action we asked the provider to take at the back of the full version of this report.

At the last inspection on 6 January 2016 we asked the provider to take action to make improvements in relation to safe care and treatment, consent, person-centred care, complaints and good governance. The service was placed into Special Measures as a result. The provider sent us an action plan to tell us what they were going to do to make improvements, however during this inspection we found that insufficient improvements had been made.

RA Care Services Limited is registered to provide support to adults living in their own homes with personal care. At the time of the inspection the service was providing care to 38 people.

The service had 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 records did not provide a clear and accurate record of the medicines staff had administered to people to ensure that they received their medicines safely. Not all staff had completed training in medicines, there was no evidence staff's competency to administer medicines was assessed and no audits were completed on medicine administration records. An audit sent to us after the inspection did not adequately identify concerns about record keeping in relation to medicines.

Risks to people's health and wellbeing were not identified and managed safely by staff. Systems in place to monitor accidents and incidents were not being followed or managed to reduce the risk of further occurrences.

People using the service and their relatives said staff did not miss their calls and the regular staff turned up on time. However, some relatives told us that staff left early and said the care provided was carried out in a hurried way. The provider told us that care workers provided care to a regular group of people and as a result staff rotas were not needed. However, we could not be assured that staff arrived on time as the records we looked at were inconsistent.

Recruitment processes were incomplete and some recruitment checks had not been verified to confirm their authenticity. Therefore we could not be assured that the provider’s recruitment processes protected people from staff unsuitable to work with them. Quality monitoring systems were ineffective and did not identify or address shortfalls in the operation of the service. Shortfalls identified at our last inspection had not been satisfactorily addressed by the management team.

The provision of ongoing supervision and performance management for staff was not consistent. Staff told us they received training. However, we found that some of the training they had received was not effective. There were no systems in place to ensure that staff had the skills and knowledge to support people safely and effectively.

We saw evidence that mental capacity assessments had been completed so that decisions could be made in a person’s best interests when they didn’t have the capacity to make a particular decision for themselves. However, where family members had signed to consent to the care and support of their family member, the provider was unable to demonstrate that the relative had the legal authority to do so and was therefore not working in line with the Mental Capacity Act 2005

Relatives told us that their family members were not always treated with dignity and respect. People were happy with the choice and quality of food. Some people and their relatives told us staff were caring and happy and did what they thought they should to support them. People's preferences had been sought and staff also offered people choices, for example with their nutritional needs. Health and social care professionals were involved in people’s care.

Care planning did not always give staff sufficient guidance about how to safely and consistently support people; records were completed incorrectly and it was evident some people's needs were not being met. When we reviewed care plans and people’s daily records we found inconsistencies and we were not always able to ascertain the exact care and support someone needed from the records. Care plans were not always reviewed to reflect people’s changing needs. People's daily care records and timesheets were inaccurate; this meant that people were at risk of receiving inconsistent care.

We found breaches of regulations in relation to safe care and treatment, fit and proper persons employed, consent, staffing, person centred care and good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service therefore remains in 'special measures'.

The service was kept under review and we have found that not enough improvement was made. Therefore we are now considering what action we will take in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

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 it will no longer be in Special Measures.

The service is registered to provide support to adults living in their own homes with personal care. At the time of our inspection 15 people were using the service. The service had a registered manager in place. 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.

We identified major concerns in the provider’s ability to meet regulatory requirements. This meant the provider could not demonstrate that they operated systems to deliver a service that was safe, reliable and consistently able to meet the care and welfare needs of people who used the service.

The recruitment procedure was not sufficiently robust to ensure that only suitable persons were employed to work with people. This increased the likely risk to the safety and welfare of people.

Whilst risks to people were assessed prior to them receiving their service, these assessments were not detailed or fully complete. The lack of adequate risk assessments regarding the health, care and safety of people and how to mitigate against them increased the risk that people may receive inadequate and unsafe care.

Staff had limited knowledge of the Mental Capacity Act (MCA) 2005 and how to apply it. This increased the risk of people’s rights not being protected in relation to decisions about their care, their right to consent or refuse care arrangements or of best interest decisions being made following the principles of the Act.

People said their nutrition needs were met by family members. However support provided by staff was not clearly stated in their plans.

People’s healthcare needs were met and the provider worked collaboratively with other health and social care agencies.

The provider was unable to demonstrate that care met the preferences of people who used the service. Care was developed after visiting and speaking with people who used the service. However care plans did not clearly state people’s views and wishes about their care arrangements. This placed people at risk of having care provided that did not meet their needs and wishes.

Whilst people described the responsiveness of the service as being good, we found significant shortfalls in the provider’s ability to demonstrate how they met people’s needs. People were consulted about their care as part of the assessment process. However assessments, risk assessments and care plans were not sufficiently developed, personalised or updated. These key documents designed to provide important information about people’s needs and service did not adequately guide staff on people’s current care and support needs and how to meet them.

The provider could not demonstrate that they took on board the complaints or concerns of people or others involved in their care. The lack of an effectively operated system for identifying, recording, handling and responding to complaints about the care service was a breach of regulations.

There were significant personnel difficulties which presented challenges to the management of the service. There had been a lack of scrutiny and effective quality monitoring of the service. This resulted in widespread shortfalls not being identified or addressed. Management did not use their quality assurance system as a means of developing and improving the quality of service.

People who used the service described staff as being kind, caring and knowledgeable about their needs. Staff received training and supervision and said they felt adequately supported.

We found breaches of regulations relating to safe care and treatment, consent, person-centred care, complaints and good governance in relation to records, quality assurance system and notifications. CQC is currently considering the most appropriate regulatory response to the concerns found and will report on this at a later date. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is Inadequate and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.