Archived: 24/7 Flex Care Ltd

About the service

24/7 Flex Care Ltd is a domiciliary care agency providing personal care. The service provides support to older people and younger adults with dementia, learning disabilities or autistic spectrum disorder, physical disability, and sensory impairment. At the time of our inspection there were 11 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. At the time of our inspection, 10 people were receiving personal care.

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

Right Support: People did not always receive safe care. Risks to people’s wellbeing had not always been identified or mitigated. This placed people at risk of harm. Medicines were not managed safely. Staff lacked training and not all staff had been recruited safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the lack of policies and systems in the service allowed this practice to take place.

Right Care: Care plans failed to record accurate and consistent information about people. This made it difficult for staff to ensure people received the right care.

Right Culture: A closed culture had developed within the service. This meant people were more likely to experience harm. The attitudes and behaviours of leaders did not ensure the service was well led.

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 inadequate (published 14 December 2022) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

This report only covers our findings in relation to the Key Questions Safe, Effective 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 remained Inadequate. 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 24/7 Flex Care Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to gaining consent to care, safe care and treatment, keeping people safe from harm or abuse, staff training, recruitment practices, good governance, and the provider’s openness and transparency.

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

The overall rating for this service is ‘Inadequate’ and the service remains 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 6 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.

24/7 Flex Care Ltd is a domiciliary care agency providing personal care. The service provides support to older people and younger adults with dementia, learning disabilities or autistic spectrum disorder, physical disability and sensory impairment. At the time of our inspection there were 14 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.

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

Care plans and risk assessments lacked detail.

Safe medicines practices were not always being followed.

Personal protective equipment (PPE) was not always worn.

Recruitment processes were not always robust.

The registered manager lacked oversight of the needs of the people they supported and did not always respond to complaints appropriately.

Systems and processes to monitor safety and quality, and care call oversight was lacking.

People were not supported to have maximum choice and control of their lives and staff did not 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.

The provider had failed to notify us of some significant events. We are currently considering our regulatory response to this issue.

Staff liaised with health care professionals in a timely way.

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.

Right Support: The lack of appropriately completed consent forms meant people’s choice, control an independence was not maximised. Staff were not always adequately trained.

Right Care: Care was not always person centred. Care plans lacked details about people’s likes, dislikes and personal histories.

Right Culture: People, their relatives and staff could not always tell us who the registered manager was. Concerns about abuse had not always been escalated, meaning people were not always protected from abuse. There was a lack of care worker understanding about their role in highlighting concerns of abuse.

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 inadequate (published 27 April 2022). 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 the provider remained in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 22 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve regarding the need for consent, safe care and treatment, good governance and fit and proper persons employed.

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.

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 Inadequate. 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 24/7 Flex Care Ltd 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. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the need for consent, safe care and treatment, safeguarding people from abuse and improper treatment, governance and fit and proper persons employed at this inspection.

Our regulatory response to this has now been concluded and can be found at the end of the report.

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.

The overall rating for this service is ‘Inadequate’ and the service remains 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 6 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.

About the service

24/7 Flex Care Ltd is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection 22 people were using the service.

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

The provider failed to ensure safe recruitment checks were carried out and available for staff who worked in the service. Risks related to COVID-19 had not always been reduced through staff testing. Medicines records did not contain directives to enable staff to administer medicines safely. Measures had not always been sought to reduce the risk of potential harm to people from known risks. Risks assessments relating to people’s care did not always detail how staff could keep people safe.

The provider failed to implement a robust and effective auditing system to monitoring people’s safety and quality of care. The provider lacked oversight of staff employed in the service, people using the service and concerns we identified during the inspection which related to medicines, care call scheduling and COVID-19 testing for staff. Audits which had been completed were not successful at identifying shortfalls in practice and feedback sought from people was not always acted on to improve the service. We received conflicting information regarding the management of the service.

People did not always receive their full care call time which was allocated to them once their care and support needs had been assessed. Staff training records were inconsistent, and some training information was not available for some staff. The provider failed to demonstrate how people’s mental capacity had formally been assessed relating to decisions about their care. Whilst some care plans contained minimal information, others contained details of external professionals who support people with specialist conditions or equipment.

People did not always feel involved with planning their care calls. Care call schedules were not planned to ensure staff had enough travel time between calls. The provider had received no formal complaints and most people felt they could raise a concern if required. People’s communication preferences were recorded in their care plan.

Most people felt they were supported by staff who knew them well. However, there were occasions where people felt rushed during their care call and staff appeared disengaged.

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 24 September 2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about proper fitness of managers and recruitment of staff. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive 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.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to medicines, risk management, COVID-19 testing, recruitment of staff, and governance and oversight.

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.

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 6 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.