Date of assessment 27 February to 10 March 2025 Choice Care 4U Services Ltd is a domiciliary care service providing support to people living in their own homes. Not everyone who used the service received personal care. 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. At the time of our assessment 27 people were receiving the regulated activity of personal care. The service supported people living with dementia, health conditions and general frailty. Some people supported had a learning disability. The provider was working in line with national best practice guidance for people with a learning disability and autistic people. The assessment was undertaken to assess improvements since the last inspection (published 19 April 2022). At this assessment improvements had been made. Risks to people were now managed safely and care plans guided safe practices. The provider now had oversight of effective quality monitoring and governance processes. Person centred practices were now embedded within the culture of the service. Learning was used to improve service delivery. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence, and good access to local communities that most people take for granted.
PDF cached but not yet analysed by Claude — set ANTHROPIC_API_KEY and re-run npm run etl:reports -- --location 1-1449825985.
Choice Care 4U Services Ltd received a 'Requires Improvement' rating following a focused follow-up inspection of Safe and Well-led, having improved from 'Inadequate' and exiting Special Measures. Key improvements were made in medicines management, safeguarding, risk assessment and governance, though discrepancies between paper and electronic care records indicated quality monitoring processes were not yet fully embedded.
Concerns (3)
moderateGovernance — “We identified some discrepancies between information held in people's electronic and paper records which the providers quality checking processes had failed to identify.”
moderateRecord keeping — “The service was operating with paper based and electronic care records whilst information was being transferred to the new system...discrepancies between information held in people's electronic and paper records.”
minorCare planning — “Some care plans were still in the process of being updated and the registered manager had a clear time scale for achieving this.”
Strengths
· Electronic medicines administration records (EMAR) implemented with real-time recording and weekly audits, ensuring medicines were managed safely.
· Electronic call monitoring system introduced to identify late or missed calls and take prompt action.
· Robust safeguarding processes implemented, including new systems for financial transactions to mitigate risk of financial abuse.
· Staff received training specific to people's needs including diabetes, dementia and epilepsy.
· Formal supervision reintroduced and delivered in line with policy, with positive staff feedback.
Quality-Statement breakdown (8)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
well-led: Promoting a positive culture; continuous learning and improving careRequires improvement
well-led: Engaging and involving people, public and staff; working in partnershipGood
Choice Care 4 U Services Ltd was rated Inadequate overall and placed in special measures following breaches of Regulations 12, 13, 17 and 18 covering safe care, safeguarding, medicines, governance and staffing. Although people reported feeling safe with kind, reliable staff, the provider had failed to assess risks, manage medicines safely, train staff adequately or operate effective governance and quality assurance systems.
Concerns (14)
criticalSafeguarding — “Systems and processes were not robust to protect people from the risk of abuse. The provider had failed to identify and mitigate practice that had the potential to expose people to harm.”
criticalMedication management — “Medicines were not always managed safety... The administration of medicines was not always accurately recorded... Medicine risk assessments lacked information about how to mitigate identified risks.”
criticalCare planning — “Risks to people were not identified and managed... where it was recorded that people had epilepsy or experienced seizures processes were not in place to identify and mitigate associated risks.”
criticalStaff training — “there were 15 staff without any record of ever having undertaken safeguarding training and there was no record of staff having access to training to meet people's specific needs”
criticalStaff competency — “One staff new to care had completed two of the 15 required standards and had passed their probation period without this being identified. They had been working alone for eight months”
criticalGovernance — “Governance arrangements were not effective in identifying shortfalls in the quality of the service... they had failed to undertake any audits or quality assurance checks.”
criticalLeadership — “there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalIncident learning — “The provider did not have a system in place to monitor or analyse incident records for trends... there were no processes for learning lessons to drive service improvements.”
criticalRecord keeping — “There was a failure to maintain an accurate, complete and contemporaneous records. This was a breach of... Regulation 17”
moderatePerson-centred care — “People did not always receive a person-centred approach to having their needs met. Assessments and risks assessments lacked important details”
moderateConsent / capacity — “Processes were not in place to ensure people were not deprived of their liberty for the purpose of receiving care without lawful consent.”
moderateSupervision / appraisal — “Staff told us they did not receive formal recorded supervision on a regular basis or an annual appraisal.”
moderateCommunication with families — “People's communication needs were not always identified or recorded in their support plans. Where a person had a severe communication impairment due to their learning disability this information had not been shared appropriately”
moderateOther — “Staff were not always recruited safely... appropriate recruitment checks had not been consistently undertaken to ensure staff were safe to work with people.”
Strengths
· People reported feeling safe with staff and trusted those supporting them
· Reliable service with no missed calls and consistent familiar staff team
· Sufficient staffing levels so people did not feel rushed and received support on time
· Effective infection prevention and control processes aligned with COVID-19 guidance
· Staff treated people with kindness, respect and compassion
Quality-Statement breakdown (18)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced diet
PDF cached but not yet analysed by Claude — set ANTHROPIC_API_KEY and re-run npm run etl:reports -- --location 1-1449825985.
Good
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier lives, access healthcare services and supportGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Promoting a positive culture; managers and staff understanding roles, quality, risks and regulatory requirements; Continuous learning and improving careInadequate
well-led: How the provider understands and acts on the duty of candour; Engaging and involving people, public and staffRequires improvement