Date of assessment 4 to 18 March 2025. Profad Care Agency Limited is a Domiciliary Care Agency (DCA) registered to provide personal care. People were supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of our assessment 139 people were using the service. The service had a manager registered with the Care Quality Commission. The manager and the provider are legally responsible for the quality and safety of the care provided. The assessment was carried out by 1 inspector. We spoke with 13 people who received care and support, or their relative or friend did. We reviewed 4 people’s care plans and a range of other documents. At our last inspection the service was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were found at this assessment and the provider was no longer in breach of this regulation. Staff now assessed and mitigated risks. Care plans now guided safe practice. People were more confident staff would arrive as expected and knew how to safely support them. Staffing levels met the needs of people. People were involved in individual assessments and decisions about their care. Staff involved those important to people in decisions for people’s best interests where they did not have capacity. People received medicines as prescribed by staff who were trained and assessed as competent to do so. Effective quality monitoring systems were in place to identify and learn lessons from incidents and when things went wrong. There was an effective management structure in place to monitor the quality the care and to drive improvements. People knew how to give feedback and were confident the provider took it seriously and acted on it. Managers and care coordinators were visible, knowledgeable and supportive, helping staff develop in their roles. People were supported by staff who felt valued by the management team.
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Profad is a domiciliary care agency providing personal care and support to people, including older people, people living with dementia and people with learning disabilities and/or autistic people living in their own homes. The assessment was carried out between 16 September to 01 November 2024 based on information of concern we received. We looked at Safe and Well-led and included some additional priority quality statements. In total, we looked at 21 quality statements. We identified shortfalls at the service and breaches in relation to good governance. The systems in place were not effective in identifying the concerns found during our assessment. These were in relation to auditing, care planning, medicines and staff scheduling. There were 160 people using the service. We made phone calls on 09 September 2024 and spoke with 13 people, receiving care and support and/or their family members. We announced our visit to the office and attended on 06 and 09 September 2024 to corroborate information. We reviewed care plans, and associated documents and spoke with 16 members of staff. We used an Expert by Experience to get feedback from people and relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
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Profad Care Agency Limited improved from Inadequate to Requires Improvement overall, having remediated prior breaches in medication, safeguarding, recruitment and governance, but residual concerns remain around incomplete staff recruitment records, poor rota communication with people, and insufficiently documented incident learning. Effective, Caring and Responsive domains were all rated Good, reflecting meaningful progress since the previous inspection.
Concerns (5)
moderateStaffing levels: “gaps in employment history, which were not accounted for, in 2 out of 3 staff files reviewed.”
moderateRecord keeping: “One staff file didn't have a reference from their most recent employer or an explanation of why although they did have 2 references in place.”
moderateCommunication with families: “People spoken with told us they didn't receive a rota, their regular care staff didn't always come for the visit and they weren't told who was coming.”
minorGovernance: “we did not find clear evidence of learning from incidents, how this was shared with the staff team and used to improve care.”
minorPerson-centred care: “Care plans contained little information to guide staff in relation to respecting and promoting people's privacy and dignity.”
Strengths
· Medicines administered safely; MAR charts completed in full and audited with clear care plan information on medicines.
· Care plans and risk assessments updated to reflect a person-centred approach with involvement of people in assessment.
· Staff received relevant induction, training, supervision and spot checks to support competency.
· Safeguarding systems and processes in place; staff confident in recognising and reporting abuse.
· Infection prevention and control training in place with sufficient PPE supplies.
Quality-Statement breakdown (25)
safe: Using medicines safelyGood
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: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
Profad Care Agency Limited was rated Inadequate overall and placed in special measures, with breaches of Regulations 12, 13, 17 and 19 covering unsafe medicines management, safeguarding failures, unsafe recruitment and absent governance oversight. Care planning, training, supervision and complaints handling were all inconsistent, although the provider was receptive to feedback and began making changes.
Concerns (20)
criticalMedication management: “Medicines were not always administered and managed safely... There was crossing out making information unclear. The records were not always initialled by staff who had given the medication”
criticalMedication management: “Relative has meds three times daily, carers do give meds but visits vary so greatly, meds are often not given on time. We have had issues with tablets not being given, finding tablets on the floor.”
criticalSafeguarding: “Failure to ensure effective systems and processes were in place to protect people from abuse and improper treatment. This placed people at increased risk of harm”
criticalStaff training: “Staff training records identified not all staff had been trained in safeguarding adults.”
criticalStaff competency: “Not all staff had received effective training in medication and been assessed as competent. One staff member told us they had not been assessed as competent to administer medicine.”
criticalOther: “Staff were not always recruited safely. There were documents missing from the recruitment process including a second reference and proof of identity in one file.”
criticalGovernance: “Failure to ensure effective systems and processes were in place to assess, monitor and improve the quality and safety of the services provided to people.”
criticalLeadership: “Management lacked oversight of the service because they didn't have the checks in place to be able to assure themselves staff were delivering good quality, person centred care.”
criticalOther: “The provider had not always made the necessary notifications to the CQC, and other agencies, when relevant incidents had occurred.”
moderateCare planning: “more recent care plans were incomplete and lacked any person centred information about how the person liked to be supported.”
moderateSupervision / appraisal: “In the last four months supervision was not being carried out regularly. Staff told us they did not receive regular supervision and the staff files reviewed supported this.”
moderateIncident learning: “The lack of oversight, actions and learning from incidents at the service demonstrated that the management team did not understand the principle of good quality assurance.”
moderateComplaints handling: “I do know what to do to raise a complaint, but don't have the confidence the agency follows up when concerns are raised. Not sure they have procedures in place to check up on things”
moderatePerson-centred care: “One person told us their support was not at a time that supported their choice and they had been told they could not change this, this was not person-centred.”
moderateMissed or late visits: “carers do give meds but visits vary so greatly, meds are often not given on time”
moderateInfection control: “we could not see evidence that all staff had effectively been trained in infection prevention and control, personal protective equipment and COVID-19.”
moderateRecord keeping: “failure to have clear and concise records in all areas to monitor and manage the service was a breach of regulation 17 (Good Governance)”
minorConsent / capacity: “not all documents had been signed and dated, so there was a risk about the validity of these documents.”
minorEnd-of-life care: “There were no end of life care plans in the documentation we reviewed.”
minorCommunication with families: “Someone sat down with [name] four weeks ago, didn't tell us it was a review.”
Strengths
· Staff files contained completed criminal record checks (DBS).
· Provider was open to feedback and began making changes during the inspection.
· Capacity assessments and Lasting Power of Attorney information were on file where necessary.
· Some positive feedback from people, e.g. 'Best thing is the carers, they are so nice, so kind to me'.
· Staff understood how to promote people's independence and respect privacy and dignity.
Quality-Statement breakdown (21)
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and support
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
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 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 supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careRequires improvement
well-led: Working in partnership with othersGood
Requires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their care; Respecting and promoting people's privacy, dignity and independenceRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires 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: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; Continuous learning and improving careInadequate
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: Working in partnership with othersInadequate