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Yes Care Limited

Overall: Requires improvement read more about inspection ratings

Allied Sanif House, 412 Greenford Road, Greenford, UB6 9AH (020) 8004 6333

Provided and run by:
Yes Care Limited

All Inspections

9 January 2023

During a routine inspection

About the service

Yes Care Limited is a domiciliary care agency providing personal care and support to people living in their own homes. At the time of our inspection one person was using the service.

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

The provider had quality monitoring processes in place to help monitor and improve service delivery. However, these were not always effective as they had not identified the areas where improvements were required which we identified during the inspection.

We made recommendations that the provider consider national guidance for best practice regarding the principles of the Mental Capacity Act (2004) around consent to care and that they consider current guidance on administering medicines and act to update their practice.

People were not always 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 assessed risks to people’s safety and wellbeing. Staff received training and supervision and the provider undertook spot checks to help ensure best practice was followed.

The person was supported by the same staff which provided consistency.

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 29 October 2020) 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 the provider remained in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified a breach in relation to good governance at this inspection. 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.

14 September 2020

During an inspection looking at part of the service

About the service

Yes Care Limited is a domiciliary care agency providing personal care and support to people living in their own homes. At the time of our inspection one person was using the service.

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

During the inspection we found evidence of inaccurate record keeping as what was written in daily care records did not accurately reflect what the provider told us about the care of a person.

At the time of the inspection, there was no registered manager in post.

At the previous inspection we found concerns regarding the use of agency staff, medicines administration and training for staff to use specific equipment in the care of people. At this inspection we were not able to make a judgement about whether improvements had been made because the provider told us they no longer used agency staff, did not administer medicines and were no longer using the equipment.

The training we saw was up to date, supervisions were being undertaken on a regular basis and the provider was completing spot checks to ensure the service user’s needs were met.

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

Rating at last inspection

The last rating for this service was requires improvement (published 24 December 2019). The breaches of regulation were in respect to recruitment, staffing, safe care and treatment and governance. This service has been in 'special measures' since April 2019. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

Why we inspected

We undertook this announced targeted inspection to check if the provider had made improvements to meet regulations 12 (Safe care and treatment), 17 (Good governance), 18 (staff) and 19 (fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which they were in breach of at our last inspection in November 2019. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices, breaches of regulations or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found there were some improvements in the service in relation to governance, so we widened the scope of the inspection to include the whole of the well-led key question and to award it a rating.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm. Please see the safe, effective and well led sections of this full report.

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

Enforcement

After the April 2019 inspection we rated the service inadequate and placed it in Special Measures. We took enforcement action against the provider and the registered manager, which included cancelling the registration of the registered manager and imposing conditions on the provider to restrict admissions. In addition further conditions were imposed on the registered provider. These included conditions to appoint a new registered manager, employ a consultant, send in monthly reports to the CQC and restrictions around admissions to the service. CQC is in the process of reviewing these conditions.

At this inspection we found the provider remained in breach of one out of four breaches of regulations identified at the last inspection. This was for a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we have asked the provider to take at the back 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

18 November 2019

During a routine inspection

About the service

Yes Care Limited is a domiciliary care agency providing personal care and support to people living in their own homes. At the time of our inspection one person was using the service.

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

We were not able to make a judgement about how the person receiving a service or their family felt about Yes Care Limited. We were also unable to obtain feedback from care workers about their experiences.

The provider did not have records to show that some of the staff deployed to provide care were suitably recruited or had the training and skills needed to provide effective care. There were no records to show staff had inductions or that some members of staff had their competency assessed.

The provider did not effectively operate systems to make sure people received their medicines safely. There was no record to show that some of the staff administering medicines were trained or competent to do so and records did not always clearly describe who had administered medicines.

The provider's systems for monitoring and improving the quality of the service and mitigating risks had not always been operated effectively because they had not made enough improvements to meet the required standards. Whilst there were some improvements these were mostly to the systems and processes which would be followed in different scenarios. These had not been tested because there was only one person using the service with a package of care which had reduced over the last few months.

The care plans and risk assessments for the person had improved. These had been developed by a clinical lead who was no longer employed by the provider. Therefore, we were not assured that future care plans and risk assessments would be of a similar quality.

There had been improvements in the way some staff were supported and supervised. These included individual and team meetings and spot checks where a senior member of staff observed how the care worker conducted themselves.

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 (and update)

The rating at the last inspection was inadequate (Published 5 June 2019). We identified breaches relating to nine of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in connection with person-centred care, dignity and respect, consent to care and treatment, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing and fit and proper persons employed. We also identified a breach of the Health and Social Care Act 2008 (Registration) Regulations 2009 relating to notifications.

We have taken action against the provider. 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.

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.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection we have identified breaches of four Regulations in relation to safe care, recruiting staff, training and supporting staff and management 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 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.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are continuing to place the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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 six 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, 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.

9 April 2019

During a routine inspection

About the service: Yes Care Limited is a domiciliary care agency providing personal care and support to people living in their own homes in the community. The provider is a privately run organisation and this is the only registered location. The agency also provides other care and support which does not include personal care. CQC is not responsible for regulating these aspects of the service. At the time of the inspection 10 people were receiving support from the agency. The registered manager told us that seven people were receiving personal care (which includes support with medicines) and three people were receiving other support. However, feedback from one member of staff which we received after the inspection visit, included information which indicated one other person was receiving support with personal care.

People’s experience of using this service:

People using the service were not safe. The risks to their safety and wellbeing had not always been assessed or planned for. The staff were undertaking tasks which they had not been trained to do and the provider had not assessed their competencies or skills. These included using medical devices and supporting people with multiple and complex healthcare needs.

The provider did not ensure the safe and proper management of medicines. Information about medicines was not always completed in people's care plans or risk assessments. The provider had not trained staff to safely manage medicines and they had not assessed their competency or knowledge regarding this. The provider had not seen or audited medicines administration records, so they could not be confident that people had received their medicines as prescribed.

People were placed at risk of abuse and harm. The provider did not ensure safeguarding procedures were followed. They provided care to children under the age of 18 years. This care had not been planned for or risk assessed. The staff had not been trained to safely care for children and when there had been incidents involving these children the provider had failed to take the appropriate action to notify the local safeguarding authority.

The provider did not have systems for learning from accidents, incidents and concerns. Throughout our inspection we identified records where staff had recorded accidents and concerns. There was no evidence these had been investigated. The relative of one person told us that when they raised concerns these had not been responded to appropriately. There was no record of these concerns or action taken by the provider.

The provider did not ensure staff were suitable to work at the service. They did not follow their own recruitment procedures because they had not carried out all the necessary checks on staff. They did not provide a comprehensive induction for staff or assess their skills and competency in any areas. There was no evidence of 'spot checks' to observe the staff in the work place or supervision meetings where the staff would discuss their work with their line managers.

The provider had not undertaken any assessments of people's capacity or obtained written consent for the care they were providing.

The staff were not always kind, caring or respectful. Some of the records staff had completed showed disrespect and contempt for the vulnerable people they were employed to care for.

Some people's needs had not been assessed or planned for. Care plans did not include how to support people with all aspects of their care. Some care plans included information which related to completely different people. In some cases, this placed people at significant risk because the documents indicated people should be offered drinks when they were unable to swallow and had been assessed as 'nil by mouth.'

The systems for monitoring the quality of the service were not being implemented effectively. The provider had failed to recognise the wide spread deficits in the service. Where concerns had been identified by the provider's own quality monitoring they had not taken action to put things right.

Following our initial feedback after the inspection visit, the registered manager explained that they had taken some action to address the concerns which we had highlighted. We wrote to them asking them for further assurances. They sent us an initial action plan and offered to provide evidence of some of the actions they had taken.

Before our inspection visit, the provider had experienced a loss of computerised records. The registered manager informed us that some of the documents which were absent at the time of the inspection were in place but could not be accessed. They told us they were communicating with the on line cloud provider in order to try and retrieve this data.

Some people who used the service were happy with the staff who supported them. In particular, one relative explained how the care staff had helped them to communicate with other healthcare professionals. Some of the staff were also happy and felt supported. They said they could ring the office staff and ask for support, and that this was given when they needed it.

We identified breaches of nine Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to person centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing, fit and proper persons employed. We also identified one breach of the Health and Social Care Act 2008 (Registration) Regulations 2009 relating to notifications.

Rating at last inspection: This was the first inspection of the service since it was registered in May 2017. There was no one receiving a service until September 2018, which is why we had not inspected before this.

Why we inspected: The inspection was carried out as part of our scheduled plan of inspections.

Enforcement:

We have taken action against the provider for failing to meet Regulations.

We have cancelled the registration of the manager and imposed conditions on the registration of the provider.

Full information about CQC's regulatory responses can be seen in our table of action.

The service has been rated 'inadequate' and is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Follow up:

We will continue to monitor the service and will undertake another comprehensive inspection within six months or sooner if needed.

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