Background to this inspection
Updated
21 September 2021
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 Care Act 2014.
Inspection team
The inspection was carried out by 4 inspectors. Two inspectors visited the office location, and two inspectors carried out remote inspection activity such as speaking to people who use the service, staff and professionals who work with the service and reviewing documents.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The service also provides nursing care to support children and adults with more complex medical needs. The service did not have a manager registered with the Care Quality Commission. This means the provider held sole legal responsibility for how the service is run and for the quality and safety of the care provided. The service had a manager in post who was in the process of registering with CQC. We were supported on the inspection by the nominated individual who is the person appointed by the service as the main point of contact with responsibility for supervising the management of the regulated activity provided.
Notice of inspection
This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because of the nature of the service and we needed to be sure that the provider would be in the office to support the inspection.
Inspection activity started on 15 July 2021 and ended on 28 July 2021. We visited the office location on 15 and 16 July 2021. After visiting the office location, we continued to gather feedback from people, staff and professionals who work with the service and review documents.
What we did before the inspection
We reviewed all the information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We sought feedback from the local authority and professionals who work with the service. We contacted Healthwatch, an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.
During the inspection
We spoke with 6 people who used the service and/or their families about their experience of the care provided. We spoke with 16 members of staff including the manager, nominated individual, managing director, clinical managers, office staff, field supervisors, nurses and care workers. We reviewed a range of records related to the service. This included eight people’s care records. We looked at three staff files in relation to recruitment and staff supervision. We reviewed a variety of documents relating to the management of the service, including policies and procedures.
After the inspection
Following our visit, we continued to review a variety of records relating to the management of the service, including policies and procedures, quality and assurance records. We contacted a range of professionals who work with the service. We continued to seek clarification from the provider to validate evidence found.
Updated
21 September 2021
About the service
Carebridge Staffing Ltd is a domiciliary care agency registered to provide both personal care and nursing care for treatment of disease, disorder or injury. The service supported adults and children living in their own homes in Kent, Hertfordshire, London and Surrey. Some people needed support with personal care; this is help with tasks related to personal hygiene and eating. Other people had more complex medical conditions and needed support from nurses. CQC only inspects where people receive personal care and/or nursing care. Where they do, we also consider any wider social care provided. At the time of our inspection 113 people were being supported with personal care or nursing care.
People’s experience of using this service and what we found
The service had expanded significantly since our last inspection and had recently gone through several staff changes in the senior management team.
Systems and processes around risk management needed to improve and that meant people were not supported in a consistently safe manner. This included risks associated with COVID-19 testing of staff and risk assessments of variable quality.
Audit and quality assurance processes were not sufficiently robust and had not identified the inconsistencies in some documentation and practice which were identified during the inspection. The provider was transparent about these areas where improvement was still required and was responsive to our feedback during the inspection. One staff member said, “We recognise there are areas we need to improve.”
The provider had a process to manage potential safeguarding concerns, alongside incidents and accidents and complaints. This process was mostly effective in identifying potential safeguarding concerns though we highlighted two issues to the provider during our inspection, which they responded to. People told us they knew who to contact if they had any concerns, though feedback from people was mixed in terms of how their concerns were responded to.
Staff knew how to recognise the potential signs of abuse and knew what action to take to keep people safe.
People were supported to maintain their health and access to health care services when they needed to. Staff and professionals told us the service sought appropriate guidance and support to maintain people's health and well-being.
People received care and support from trained staff who knew them well. The service employed both carers and qualified nurses for more complex care. There was enough staff to support people safely and the provider had safe recruitment procedures and processes in place. People received their medicines safely from staff who were trained and competent to do so.
Staff told us that while the service had been through a recent period of change, they felt supported. One member of staff said, “There’s room for improvement but I enjoy my job, I like serving people.” Another said, “They’ve given us such opportunities, all the support behind us.”
The service had a philosophy of “Care First”. People told us the staff who supported them were caring. One person said, “The carers are very, very good.” Another person said, “They know what to do, they are attached and loving and well trained.”
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well- led sections of this report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carebridge Staffing Ltd on our website at www.cqc.org.uk.
Enforcement
We have identified breaches of regulation 12 (safe care and treatment) and regulation 17 (good governance] of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress.