Date of assessment: 2 July to 15 August 2024. Care at Home Group Cheshire West ad Wirral provides personal care to people in their own homes. There were 72 people using the service and in receipt of personal care when we carried out the assessment. This assessment was prompted by information we held about this service. We looked at 24 quality statements and found the service was safe for people to use. The provider had made some improvements since our previous inspection. The provider was now working to ensure they had good governance and effective systems for monitoring people’s cares and had worked in partnership with the local authority. They had recruited a new management team and made other changes to the way the service was organised. There had been a focus on ensuring care calls took place as people expected, and staffing met their preferences. However, this needed going improvement. Managers were focused on the oversight and development of staff training and supervision. The rating had improved to good overall. For the key question and quality statements we did not assess, we used the ratings awarded at the last inspection to calculate the overall rating. The service had made improvements and are no longer in breach of regulations. Whilst we were preparing our report, the provider informed us the registered manager had left the service and a new manager had been appointed. We will continue to monitor information we receive about the service, which will help inform when we next assess them. During the assessment we identified an issue in relation to the provider's registration, which we are dealing with separately.
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Care at Home Group Cheshire West and Wirral was rated Requires Improvement overall on its first inspection, with a breach of Regulation 17 for ineffective governance systems that failed to identify issues around medicines management, recruitment, safeguarding notifications and visit punctuality. Caring and Responsive were rated Good, with person-centred care plans and respectful staff, but inconsistent leadership, high staff turnover and poor office responsiveness undermined quality and safety.
Concerns (10)
criticalGovernance: “Failure to ensure effective systems are in place to monitor the quality and safety of the service...is a breach of Regulation 17 of the Health and Social Care Act 2008”
criticalSafeguarding: “CQC had not been informed of all notifiable incidents, such as safeguarding concerns. Failure to notify the Commission of these events is an offence.”
moderateMedication management: “Medicines were not always administered in line with people's plans of care...staff had left medicines for the person to take later.”
moderateRecord keeping: “Records regarding who a service was provided to, and staff employed, were not always maintained accurately as differing information was provided during the inspection.”
moderateMissed or late visits: “There were incidents when they were up to 3 hours late. They didn't ring to tell me...The morning call can be anytime from 9.30-11.30.”
moderateStaff competency: “The new staff are terrified of the hoist, they don't know how to use it...Sometimes I have to explain to staff what to do, especially with the moving and handling equipment.”
moderateStaff training: “Despite the training recorded, people raised concerns about the knowledge and skills of some staff, particularly the more recently recruited staff.”
moderateLeadership: “Several new managers in the past year, which has led to a lack of communication, rota's being changed without notice and a lack of training.”
minorConsent / capacity: “Information regarding Power of Attorney (POA) was not always clear within people's care files and when records stated this was in place, there was not always evidence to support it.”
minorIncident learning: “We were told team meetings had taken place, but these could not be evidenced as they have not been recorded.”
Strengths
· Care plans were detailed, person-centred and regularly reviewed, reflecting people's preferences, medical needs and life history.
· Most people felt treated with respect and dignity; staff who knew people well were described as kind, caring and respectful.
· Infection prevention and control procedures were effective, with PPE used appropriately and policy kept up to date.
· Referrals to health and social care professionals were made promptly when concerns about people's wellbeing arose.
· A complaints log was maintained with investigation details and lessons learnt, and concerns were usually resolved when raised.
Quality-Statement breakdown (21)
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
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
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Promoting a positive culture; Continuous learning and improving careRequires improvement
well-led: Duty of candour; Managers and staff being clear about their roles and regulatory requirementsRequires improvement
well-led: Engaging and involving people, the public and staff; Working in partnership with othersRequires improvement