Care 4 Care Headquarters is a domiciliary care agency registered with the Care Quality Commission (CQC) to provide personal care and support to people living in their own homes. At the time of this assessment 37 older people were receiving personal care and support from this provider. Most people currently using the service were receiving short-term palliative end of life care. The service was rated requires improvement overall with multiple breaches of regulation made following their last inspection. This was because we identified concerns in relation to how the provider coordinated staffs call visits, operated their governance systems and maintained records. We undertook this follow up assessment to check the provider had followed the action plan we required them to send us after their previous inspection and made the necessary improvements they told us they would. The inspection was announced and we gave the provider 48 hours’ notice. This was because we needed to be sure the registered manager would be in their offices to support this assessment. Inspection activity started on 10 July and ended on 15 July 2024. We visited the provider’s offices on the first day of this assessment. We looked at 3 key questions and all the quality statements associated with them. We found the provider had made enough improvements and no longer in breach of regulations. The service is now rated good overall. Areas where the provider had improved since their last inspection included, better scheduling of staffs call visits, operating their oversight and scrutiny systems more effectively, and maintaining better records. Inspection (assessment) activity started on 10 July and ended on 15 July 2024. We visited the provider’s offices on the first day of this assessment. We found the provider had made enough improvements and was no longer in breach of regulations.
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Care 4 Care Headquarters was downgraded from Good to Requires Improvement following two breaches of regulation, with poorly coordinated visit scheduling causing late calls and inconsistent staff continuity (Regulation 18) and ineffective governance and record-keeping particularly around complaint outcomes (Regulation 17). The service remained Good in effective and caring domains, with strong safeguarding, medicines management, person-centred care and partnership working.
Concerns (7)
criticalMissed or late visits: “staff were over 15 minutes late for their scheduled calls approximately 15 percent of the time, contrary to the providers expectations regarding staff time keeping.”
criticalStaffing levels: “the provider had failed to ensure enough staff were always sufficiently deployed to enable them to attend their scheduled visits on time. Regulation 18(1)”
criticalGovernance: “the providers governance systems were clearly not always operated effectively enough to minimise the risks associated with them. This placed people at risk of harm and represents a breach of regulation 17”
moderatePerson-centred care: “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.”
moderateComplaints handling: “no records were kept by the provider in relation to the outcome of any investigations they had carried out and how they had responded to the complainants.”
moderateRecord keeping: “records they were expected to keep were not always appropriately maintained. Regulation 17(2)(a)(c)”
moderateStaff training: “Staff had not received any mental capacity or deprivation of Liberty Safeguards training. In addition, staff who cared for and supported people with autism and mental health care needs had not received any autism or mental health awareness training.”
Strengths
· Robust pre-employment checks including DBS for safe recruitment
· Effective safeguarding systems and staff training to recognise and report abuse
· Up-to-date risk assessments and management plans in care plans
· Strong infection prevention and control practices including COVID-19 measures and PPE use
· Well-organised electronic medicines system with no recording errors found
Quality-Statement breakdown (22)
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: Meeting people's communication needsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support; duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood