Companion Homecare provides personal care to people in their own homes. The service is based in Preston and also provides support to people living in the Morecambe area. 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. The inspection was prompted in part due to concerns received. A decision was made for us to inspect. Staff did not always feel there was a positive learning culture. People’s safety was not always being fully protected. Staff knowledge around safeguarding was mixed. Risks weren’t always being appropriately managed. Staff did not always receive appropriate training and support. Staff raised concerns in relation to medicines management. Feedback from staff about the management and leadership at this service was mixed.
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Companion Homecare improved from Requires Improvement to Good, having resolved previous breaches of regulations 12(1) and 17(1) relating to medicines management and governance. Recruitment processes remained partially unembedded, with outstanding recommendations around DBS checks, reference obtaining, and visit time monitoring.
Concerns (5)
moderateRecord keeping: “we found 1 occasion where written records of an interview were not kept, and sometimes only 1 reference instead of 2 were obtained.”
moderateStaff competency: “on some occasions the registered manager relied on DBS checks from previous employment. CQC guidance states there should be a new DBS check within 3 months.”
minorMissed or late visits: “some people told us that occasionally staff did not stay for the correct length of time. The registered manager had commenced electric monitoring of this.”
minorMedication management: “more detailed information was still required [for 'as and when required' medicines]. The registered manager addressed this immediately by completing new forms.”
minorIncident learning: “There was an incident recording policy however more detail was required, which the registered manager confirmed would be addressed.”
Strengths
· Medicines management improved; provider no longer in breach of regulation 12(1); audits, stock checks and competency checks in place.
· Safeguarding training provided to staff; up-to-date policy accessible; staff able to describe correct reporting process.
· Governance improved; provider no longer in breach of regulation 17(1); regular audits and risk assessment reviews now in place.
· Care supervisor conducts spot checks of staff competence; issues addressed promptly.
· Positive staff culture; high morale; registered manager praised for responsiveness and support.
Quality-Statement breakdown (10)
safe: Staffing and recruitmentNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive, and empoweringNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
Companion Homecare received an overall rating of Requires Improvement at its first CQC inspection, with regulatory breaches found in safe care and treatment (Regulation 12) and good governance (Regulation 17), principally due to unsafe medicines management, inadequate risk assessment documentation, and absent quality monitoring systems. Caring, effective and responsive practice was rated Good, with staff praised for their kindness and person-centred approach, though inconsistent visit times and incomplete record-keeping remained recurring concerns.
Concerns (10)
criticalMedication management: “Guidance for staff to follow when administering as and when required medicines was not always available.”
criticalMedication management: “People's records were not always clear as to whether their medicines were prompted or administered by staff.”
criticalCare planning: “Assessment records did not always provide a detailed plan for managing the risks...not fully reassured that measures were in place to manage risks associated with diabetes, moving and handling.”
criticalGovernance: “The provider had failed to make sure there were effective systems in place to monitor risk and performance of the service. Breach of regulation 17(1).”
criticalSafeguarding: “Not all incidents and allegations had been notified, as legally required, to us.”
moderateIncident learning: “They were not consistently monitored to identify lessons learned, themes or trends.”
moderateRecord keeping: “We found some documentation in care plans and risk assessments was not always completed in full.”
moderateMissed or late visits: “One person said, 'The visit times vary.' Another person told us, 'Sometimes they are half an hour early, which is not convenient.'”
moderateStaffing levels: “One member of staff said, 'Sometimes the times where you next have to be coincided with the time you're leaving someone, so no time allocated for travelling.'”
moderateGovernance: “Questionnaires about the service performance and quality were gathered from staff, relatives and people using the service. However, they were not analysed.”
Strengths
· Staff treated people with respect, dignity and kindness; people were very complimentary about care staff.
· Staff completed relevant training and had competencies checked before providing care.
· Effective partnership working with GPs, pharmacists, district nurses and multidisciplinary teams.
· Effective complaints procedure in place; people knew how to raise concerns.
· People and relatives could remotely access the electronic care planning and rota system.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
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
effective: Supporting people to eat and drink enough to maintain a balanced diet
Good
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsRequires improvement
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 requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Working in partnership with othersGood
well-led: How the provider understands and acts on the duty of candourRequires improvement