Care 4 Care Headquarters

Care 4 Care Headquarters is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection 46 people were receiving a home care service from this provider.

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

The service was not always safe. Staffs scheduled visits were not always well-coordinated and managed. This meant people did not always receive their personal care and support on time from the same group of staff who were familiar with their needs, preferences and daily routines.

The service was not always responsive. People’s complaints and concerns were dealt with by the provider, but this was not always done in an open and transparent way. We have made a recommendation about the provider records how they manage complaints.

The service was not always well-managed. At our last inspection the provider had failed to consistently maintain all the records they were expected to keep and ensure they were made easily accessible on request. We discussed these recording issues with the provider at the time and at this inspection we found some improvements had been made. However, these were not enough and further improvements were still required, especially in relation to how the provider recorded the outcome of complaints they had investigated.

In addition, the provider did not always operate their governance systems effectively because they had failed to identify and/or take appropriate action to address a number of issues we found during this inspection an described throughout this report.

People were kept safe from abuse and risks they might face were suitably assessed and managed. Staffs fitness to work in adult social care had been thoroughly assessed. Staff followed current best practice guidelines regarding the prevention and control of infection, including those associated with COVID-19.

People were care for and supported by staff who were suitably trained and supported to effectively perform their roles and responsibilities. Assessments of people's support needs and wishes were carried out before they started receiving any support from this provider. 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. Where staff were responsible for preparing people's meals and/or assisting them to eat and drink, people were supported to access food and drink that met their dietary needs and wishes. People were supported to stay healthy and well, and to access relevant community health and social care services as and when required.

People's care plans were person-centred, which helped staff provide them with the individualised home care and support they needed. Staff ensured they communicated and shared information with people in a way they could easily understand. People were encouraged to make decisions about the care and support they received at home and staff respected their informed choices. Where appropriate, people's end of life wishes and contacts were known and recorded for staff to refer to.

The relatives of people using the service, community health and social care professionals and staff who worked for this provider were complimentary about the way the registered manager/owner ran the service. The registered manager promoted an open and inclusive culture which sought the views of people using the service, their relatives and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people's packages of home care.

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 good (published 18 April 2018).

At our last inspection we discussed with the provider their record keeping, which needed to be improved. At this inspection we found the provider had made some progress to improve how they maintained records they were expected to keep however, further improvements were still required.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at our last inspection. The inspection was also prompted in part due to concerns received about staff recruitment and punctuality. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements to the way they coordinate staff home care visits, records how complaints are managed and how they operate their quality monitoring systems.

We found no evidence during this inspection that people had been harmed however, the failures described above had placed people at risk of being harmed. The overall rating for the service has therefore been changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Care 4 care Headquarters 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 two breaches at this inspection in relation to how the provider coordinated staffs home care visits and manages their governance and record keeping systems.

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 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.

Eight out of the 11 people currently using Care 4 Care Headquarters received an activity regulated by the Care Quality Commission (CQC). The CQC only inspects the service being received by people provided with ‘personal care’, which includes 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 in post who was also the owner. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

This provider was newly registered with the CQC in February 2017. This comprehensive inspection is the first time this new home care agency will have been inspected and rated by us. At this home care agency’s inaugural inspection we have rated them ‘Good’ overall and for four out of five of our key questions ‘Is the service safe, effective, caring and responsive?’ This was because we found the service was meeting all the regulations.

However, we have rated them ‘Requires Improvement’ for the key question, ‘Is the service well-led?’ This was because records kept by the service had not been maintained in such a way as to ensure they were always easy to access. We discussed this record keeping issue with the registered manager who agreed to review the way they organised and filed records they kept in the office. Progress made by the provider to improve their record keeping and filing practices will be assessed at their next inspection.

People and their relatives told us they were happy with the standard of home care and support they received from Care 4 Care. They also said staff working for this agency always treated them with kindness and respect. Feedback we received from community social care professional’s supported this.

People felt safe with the staff who provided their care and support. There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. Recruitment procedures were designed to prevent people from being cared for by unsuitable staff. When staff handled medicines on behalf of people they managed them safely and ensured people received their medicines as prescribed.

People did not have any concerns about staff turning up late or missing a scheduled visit. This indicated there were sufficient numbers of staff available to support people. Staffing levels were continuously monitored by managers and senior staff to ensure people experienced consistency and continuity in their care and that their needs could be met at all times.

Staff received appropriate training and support to ensure they had the right knowledge and skills to effectively meet people’s needs. Managers and staff adhered to the Mental Capacity Act 2005 code of practice. People were supported to eat healthily, where the agency was responsible for this. Staff also took account of people’s food and drink preferences when they prepared meals. People received the support they needed to stay healthy and to access healthcare services.

People and their relatives told us their regular carers treated them or their family member with the utmost dignity and respect. They ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received personalised support that was responsive to their individual needs. People were involved in planning the care and support they received. Each person had an up to date support plan. People felt comfortable raising any issues they had about the provider. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

The provider had an open and transparent culture. They routinely gathered feedback from people using the service, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided. Staff felt supported by the managers.