Archived: React Homecare Ltd

React Homecare Ltd is a domiciliary care service providing personal care to people in their own homes in Scarborough, Pickering, Helmsley and surrounding areas. At the time of our inspection there were 78 people 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.

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.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

People told us they were provided with safe care, but timekeeping and consistency was an issue. The provider was open and honest with regards to the current recruitment issues and problems this present with regards to consistency. They had clear plans in place to address this and continued to communicate with people about how this was progressing. We have made a recommendation about consistency and allocation of care calls.

People and relatives spoke highly of staff who supported them and their kind and caring approach. Safe recruitment processes were in place and followed. Staff were supported by the management team and an open, honest culture was adopted.

Improvements had been made to medicine management. Thorough guidance was now in place with regards to topical medicines, such as creams and where they should be applied. Staff responsible for administering medicines had received appropriate training and competency assessments.

Risks to people were identified and recorded. These were regularly reviewed to ensure they remained up to date and relevant. Any safeguarding concerns had been appropriately reported and staff worked with other professionals to ensure people received care and support to meet their needs and achieve good outcomes.

Effective systems were in place to monitor and improve the service. The provider visited the service on a regular basis to ensure they had appropriate oversight. People, relatives and staff were provided with the opportunity to feedback on the service provided. Action was taken to address any areas of concern.

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 22 June 2021) and there was a breach 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

We carried out an unannounced focused inspection of this service on 19 May 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance processes.

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 and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

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

React Homecare is a domiciliary care service providing personal care to people across Scarborough and Richmond. The service was supporting 157 people at the time of our inspection, including those living with dementia, physical disability, older people, younger adults and people who misuse drugs and alcohol.

Not everyone who used the service received personal care. CQC (Care Quality Commission) 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

The provider was aware of the need to develop their governance processes to ensure better oversight. However, this had not been embedded since the last inspection. Records and risk assessments did not always contain essential, up to date information and guidance for staff. Supporting documentation around medicines such as risk assessments and body maps for creams were not always in place, though, medicine administration was safe.

Some checks and audits were in place, but these were not robust or effective enough to identify issues found on inspection.

Care calls were not always timely and communication around late calls was inconsistent. People also told us they wanted to be informed which staff would be supporting them prior to the call. The registered manager was going to explore how to effectively communicate this to people.

People felt safe and confident in staff’s ability to provide care and gave positive feedback. Staff demonstrated a commitment to their role as carers and spoke positively about the provider and the support they received.

One person told us “One of the ladies was absolutely wonderful and she stayed with Dad through the night when he was dying. She was unbelievable. Mum is very close to her and she checks to see how Mum is managing from time to time. She is dedicated to what she does. My daughter, Mum and I think she and the carers are absolutely wonderful.”

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.

Rating at last inspection and update

The last time we inspected this service the provider was called Clarity Homecare Limited, this was a name change only and the premises and management team has not changed. The rating was requires improvement (published 24 December 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had 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 two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating and intelligence around potential risk.

You can see what action we have asked the provider to take at the end 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 monitor the service 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 governance at this inspection.

Follow up

We will request an action plan for 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. If we receive any concerning information we may inspect sooner.

Clarity Homecare is a domiciliary care service providing personal care to people across Scarborough and Richmond. The service was supporting 90 people at the time of our inspection including those living dementia, physical disability, older people and younger adults.

Not everyone who used the service received personal care. The Care Quality Commission (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

Significant improvements had been made to the service following a review of the service and its culture by the provider. Positive changes were noted by people using the service and staff.

Audits carried out by the provider and registered manager were not always recorded to show how safety and quality was monitored. The provider’s systems had not identified issues we found on inspection with records. It was not always clear how changes were being introduced in a planned way. The provider had developed a new quality assurance system to monitor safety and quality which was due to be introduced.

The provider had not notified CQC of about incidents of abuse and serious injuries. This was a breach in regulation and will be considered outside of the inspection process.

People felt safe with the staff supporting them. Staff understood how to reduce risks to people. Safe medicine arrangements were followed to ensure people received these as prescribed. There were enough staff to provide people’s care visits.

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 in place were not always followed to record where decisions were made in people’s best interests.

We have made a recommendation about the provider implementing better records to evidence they are following the Mental Capacity Act 2005.

People received effective care from knowledgeable, trained and skilled staff. Staff followed current best practice when providing care. Staff development and wellbeing was supported.

People responded positively to the warm, kind and patient support provided by staff. Staff were dedicated to improving people’s quality of life and independence. People felt their dignity was respected.

Appropriate and responsive care was provided to people by staff who understood person-centred care. Staff read people’s care plans before supporting them, helping them to understand their care requirements and preferences. People’s care plans were reviewed and updated following changes in their needs.

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 April 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to good governance and failure to submit statutory notifications 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 for the provider to understand what they will do to improve the standards of quality. 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.

Where services support people with learning disabilities or autism we expect them to be developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/ or autism to live meaningful lives that include choice, control and independence. People using the service did not always received planned and coordinated person-centred support that was appropriate and inclusive for them.

People’s experience of using this service: We identified widespread and significant shortfalls with the leadership of the service. The provider had not submitted statutory notifications to the Commission to tell us about significant events. This has been reviewed outside of the inspection process and is not being pursued. The manager and provider did not follow their systems to check safety and quality issues within the service. The issues we found during our inspection had not been identified by the provider. The provider was not responsive when we highlighted our concerns to them.

People and staff were not always engaged in the running of the service. Care workers did not always feel supported. They reported having difficulties accessing the team leader on-call for unplanned or emergency support.

Information was not available to help guide staff about the support people needed to manage risks or specific health conditions. At times this meant staff did not know how to respond. Medicines were not always managed safely. Staff were not clear of their responsibilities to order and collect people’s medicines and medicines were not audited effectively to identify any recording issues.

It was not always clear that there were sufficient staff to cover people’s care visits.

Training was not delivered by a qualified member of staff. Staff had not received training in key areas.

People told us they received variable experiences of care, with new staff lacking understanding of their care needs. This meant people were not always confident in the care they received.

Care plans were not always available to help staff understand the support people required. At times this meant people did not receive the care they required. Staff supported people with end of life care. They did not have the information and training needed to help them understand this specific life stage.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support as care was not always person-centred and people’s choices were not always taken into account or shared with staff.

People described having positive, supportive relationships with care workers. They felt they were treated with dignity and respect.

More information is in the detailed findings, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: This is the first inspection of the service since registering in March 2018.

Why we inspected: This was the first scheduled inspection of the service.

Enforcement: We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around person-centred care, safe care and treatment, good governance and staffing. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least good.