Background to this inspection
Updated
14 December 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team consisted of one inspector and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 24 October 2022 and ended on 04 November 2022. We visited the location’s office on 24 October 2022.
What we did before the inspection
We reviewed information we had received about the service since registration. We sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We looked at notifications received from the provider. A notification is information about important events which the provider is required to tell us about by law. This ensured we were addressing any areas of concern. We used all of this information to plan our inspection.
During the inspection
We spoke with five people and two relatives of those using the service. We spoke with five staff including the registered manager, and we contacted the funding local authority for feedback about the service.
We reviewed a range of records. This included six people's care records. We reviewed care records remotely through the provider's secure portal. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including audits and policies and procedures, were reviewed.
Following our visits to the office, we continued to seek clarification from the provider to validate evidence found. We looked at training data, electronic monitoring data and quality assurance records off site.
Updated
14 December 2022
About the service
All-Care ltd- Oxford Branch is a domiciliary care service providing the regulated activity of personal care. The service provides support to people living in their own homes. At the time of our inspection there were 65 people using the service.
The service also supports people who are discharged from hospital and require support with rehabilitation for an initial proposed period of six weeks. People receiving this rehabilitation care are referred to by the service as ‘reablement care clients’. At the time of inspection 18 people out of 56 who were receiving a regulated activity were in receipt of a reablement care package.
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 were not always protected from the risk of harm. Care plans did not always contain information specific to people's needs or contain information on how to support people to manage any conditions they had. Staff were not always provided with detailed guidance to follow when supporting people with complex needs.
Medicines were not always managed safely as records did not contain information about risk or management of medicines. The provider had an auditing system which included auditing medicines; however, shortfalls found during inspection were not always picked up by these audits.
Staff we spoke with understood their responsibilities to report concerns. There was not a sufficient number of staff available to keep people safe and meet their needs, we heard from people using the service that often staff were late, that the allocated 7am-11am window was not meeting people’s needs and there were occasions where morning calls were missed.
When incidents or accidents occurred, it was not always clear these were investigated, and if any lessons were learnt. There were systems in place to monitor the safety and quality of the service. However, there were shortfalls in ensuring all documentation was accurate and up to date across people’s records.
People and their families gave mixed feedback about being involved in the planning of their care. Some people's records contained conflicting information leading to uncertainty about what people's up to date care and support needs were. These risks were mitigated as staff had good knowledge of the people they were supporting.
People's dignity and privacy were respected, people and relatives gave good feedback about staff being kind, caring and respectful.
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
This service was registered with us on 10 November 2021 and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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 person centred care (Regulation 9), safe care and treatment (Regulation 12), good governance (Regulation 17) and staffing (Regulation 18).
You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.