Choices Healthcare Limited is a domiciliary care agency providing personal care for people living in their own homes in the community. The service provides care to older people, those living with dementia, physical disabilities and sensory impairments. This assessment was undertaken remotely and started on 17 January 2024 and ended on 14 February 2024. At the time of this assessment 104 people were being supported with personal care at the service. The last rating for this service was requires improvement (published 15 February 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this assessment we found improvements had been made and the provider was no longer in breach of regulations. We looked at 10 quality statements; Safeguarding; Involving people to manage risks; Safe and effective staffing; Infection prevention and control; Kindness, compassion and dignity; Listening to and involving people; Independence, choice and control; Equity in experiences and outcomes; Learning improvement and innovation and Governance management and sustainability.
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Choices Healthcare Limited was rated Requires Improvement overall following a December 2022 inspection triggered by increased safeguarding concerns and complaints, with four regulatory breaches identified covering recruitment, staffing, infection control and governance. While care plans were detailed and personalised and staff culture was largely positive, persistent late and missed visits, unsafe recruitment practices, and ineffective quality monitoring systems undermined the safety and consistency of care.
Concerns (10)
criticalStaffing levels — “Staff were late and did not stay for the expected time; it was rare for people to receive a call to advise the care worker would be late.”
criticalStaff competency — “Some staff had been recruited without all the required information. 4 had unexplained gaps in employment history, 1 did not have any photo ID and 1 only had 1 reference.”
criticalInfection control — “The provider's infection prevention and control policy was not dated, there was no information about if or when it would be reviewed, and COVID-19 was not mentioned.”
criticalGovernance — “The service's data regarding missed and late visits was not reliable... the service's audits were not robust. They had not identified risk assessments which were either missing or lacked detail.”
moderateMissed or late visits — “The morning call should be 9am to 9.30am. Carers have come at 12pm. There had been at least 1 missed visit in 7 out of the past 11 months.”
moderateStaff training — “There was not a tracker for staff competencies, spot checks and supervisions and the training tracker was not completed fully.”
moderateCare planning — “Risk assessments at the supported living service were very basic and lacked detail. One person's file did not have risk assessments for their oxygen and bed rails.”
moderateMedication management — “Staff were not all up to date with their medicine administration training... no overall analysis to show how many medication errors had occurred to show themes.”
moderateIncident learning — “Medication audits of individual clients showed where errors had occurred, and actions identified but there was no overall analysis to show themes among staff or clients involved.”
minorEnd-of-life care — “People's files did not include care plans specific to their wishes at end of life.”
Strengths
· People's care plans were very detailed and personalised, reflecting a good understanding of people's needs including communication, sensory and health needs.
· Staff felt well supported by managers and described an open, approachable management culture.
· The service worked proactively with external health and social care professionals, including SALT and Dementia Intensive Support teams.
· People generally felt safe and described staff as caring, patient, friendly and respectful.
· The service logged all complaints including informal ones and categorised them to identify themes.
Quality-Statement breakdown (23)
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongGood
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 lawGood
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: Ensuring consent to care and treatment in line with law and guidanceGood
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 careGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships and follow interestsGood
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 requirementsRequires 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: Continuous learning and improving careRequires improvement