Care and Respite England Ltd

At the time of our inspection, 11 people were using the service, but only 6 people were receiving the regulated activity of 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 and their relatives were positive about the staff who supported them. Staff were positive and motivated to deliver a good service. Staff knew people well and there was a supportive and family orientated culture.

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.

A small group of staff ensured people received consistent care which reflected individual needs and preferences. Improvements had been made to staff records and recruitment procedures since the last inspection.

Improvements had been made to the provider’s systems and processes to ensure people were kept safe from avoidable harm. Staff received training and incidents were reported and investigated as necessary.

Improvements had been made to ensure medicines were managed safely. An electronic recording system ensured records were completed accurately and meant people received medicines as prescribed.

Risk assessments were clearly recorded and up to date. This helped staff to identify, manage and reduce the risks involved in supporting people and provide safe and personalised support.

Quality assurance systems had been put in place to identify shortfalls and make ongoing improvements to the service. Audits had not been in place for long, but appeared to be comprehensive and would highlight concerns. We have made a recommendation about embedding quality assurance systems.

There had been improvements to the management of the service and people were generally positive about this. We have made a recommendation about management systems and processes.

Time and effort had been put into prioritising and implementing changes and improvements since the last CQC inspection. The provider was keen to learn lessons and develop the service for the benefit of people who used it, their relatives and staff.

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 January 2023) and there were breaches of regulations. We served the provider with a warning notice under Section 29 of the Health and Social Care Act 2008 because of failure to comply with regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations and had met our recommendations. We have therefore withdrawn the warning notice.

Why we inspected

We carried out an announced inspection of this service on 12 and 20 October 2022. Breaches of legal requirements were found, and we served a warning notice in relation to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check the provider 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care and Respite England Ltd on our website at www.cqc.org.uk.

Recommendations

We have made recommendations in relation to continuing to develop quality assurance systems and improve management processes at this inspection.

Follow up

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

Care and Respite England is a domiciliary care agency that provides personal care to people living in their own home. 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 there were 17 people receiving support with their personal care.

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

The provider had no systems in place to audit the quality of the service and safe recruitment checks were not always in place or available during the inspection. Records relating to the undertaking of the regulated activity were not always available.

We recommend the provider reviews the legal requirements for the safe recruitment of staff and these records are accessible and available within staff files.

People received their medicines safely and care plans contained important information relating to what medicines people required and when. People were supported by staff who knew how to identify abuse and who to raise concerns with. People and relatives were happy with the care and support and all felt safe.

Staff had received their Covid-19 vaccines and were part of regular testing. The logging of the tests were not being undertaken so that the provider had a record of the test for monitoring purposes. Staff had access to plenty of personal protective equipment (PPE) and they knew how to use their PPE safely.

People, relatives, staff and professionals all spoke highly of the service. Various verbal and written compliments had been received about the care and support from the registered manager and the staff. People were supported by staff who gave them choice and control and who promoted their independence and treated them with dignity and respect.

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.

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

Rating at last inspection; This service was registered with us on the 14 May 2019 and this is the first inspection.

Why we inspected

This was a planned inspection based on the length of time since the service registered with us.

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.

Care and Respite England Ltd is a domiciliary care agency that provides personal care to people living in their own home. 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 there were 18 people receiving support with their personal care.

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

The provider had failed to ensure systems were in place to identify shortfalls found during this inspection. Shortfalls included recruitment processes not being followed, missing signatures on medicines administration records, and people having their planned visits cut short and missed and bills not reflecting what planned care people had received. Inaccurate and incomplete records relating to staff files and systems had failed to ensure concerns were identified and acted upon.

People and staff were experiencing the impact of care staff who had left and who were yet to be replaced. This at times affected the management of the office. The provider sought feedback from people, relatives and staff through provider questionnaires. Records confirmed feedback was positive although this did not reflect the feedback we received during this inspection.

The registered manager worked in partnership with local health care professionals and they had a positive working relationship with them especially around end of life care. People felt supported by staff who they had built positive relationships with. Not all relatives and people were happy with the management of the service, including the culture of the organisation. Staff knew people well and they had a good understanding of the different types of abuse and who to report concerns to.

People’s care plans had important information relating to medical conditions and any diagnosis which could affect their short-term memory. The registered manager confirmed all people at the time of the inspection had capacity.

Rating at last inspection

The last rating for this service was requires improvement (published August 2021) and there were breaches of regulation.

Following the inspection, CQC took enforcement action against the registered manager and the provider. We continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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.

Why we inspected

The inspection was prompted in part due to concerns about there being a lack of staff, lack of care plans and people not receiving their visits as required. A decision was made for us to inspect and examine those risks.

As a result of the concerns we had received we undertook a focused inspection to review the key questions of Safe and Well-led only.

During this inspection we found breaches of Regulation. More information can be found below under enforcement.

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 remained Requires Improvement.

Enforcement and Recommendations

Following our last inspection the registered manager and provider had failed to demonstrate compliance in line with our regulations. We are taking enforcement action but cannot yet publish actions due to representations and appeals process.

At our last inspection we recommended that the provider reviewed their recruitment procedure in line with their recruitment policy and legal requirements. At this inspection we found no improvement had been made. The providers recruitment policy was not being followed along with legal requirements. This was a breach of Regulation 19.

During this inspection we identified a repeated breach of Regulation 17. We have issued a warning notice where the registered manager and provider must ensure compliance.

A new recommendation has been identified in relation to ensuring there are enough staff employed to meet the needs of the service.

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 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.