Kare Support Services Ltd

Updated 21 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by one inspector and was announced.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post. The registered manager was also the nominated individual. They are responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

Prior to the inspection we looked at all the information we had collected about the service including notifications the registered manager had sent us. A notification is information about important events which the service is required to tell us about by law. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 14 April 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager and reviewed a range of records. These included two people's care records. We also looked at a variety of records relating to the management of the service, including recruitment information for two staff, quality assurance, spot checks and observations, policies and procedures.

After the inspection

We contacted people and relatives for feedback and received two responses. We also contacted three more staff and received feedback from them. We looked at further training data, policies and recruitment information for two staff members sent to us after the inspection. We sought feedback from the local authority and professionals who work with the service and received one response.

Updated 21 July 2022

About the service

Kare Support Services Ltd is a domiciliary care agency that provides personal care to people in their own homes. It provides a service to older people who have dementia, learning disabilities or autistic spectrum disorder, mental health needs or physical disability.

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 inspection there were two people using the service.

People’s experience of using this service and what we found

The registered manager did not operate effective quality assurance systems to oversee the service. They had not identified the concerns we found through their own monitoring systems.

The registered manager did not ensure effective and safe recruitment processes were in place to ensure, as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines was not always safe. Not all staff were up to date with, or had received, their competency checks and mandatory training. We did not have enough evidence to show the registered manager kept their knowledge and competencies checked and up to date.

The registered manager was able to describe how incidents or accidents were responded to. However, we were not assured they effectively identified, reported and investigated safeguarding concerns. People’s records for risk management needed reviewing to ensure more detail about how to minimise and mitigate risks were available to staff. The registered manager did not inform us about notifiable incidents in a timely manner. The registered manager did not ensure that clear and consistent records were kept in relation to people’s care and the service management. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

We have made a recommendation about seeking guidance from a reputable source to ensure the Mental Capacity Act (MCA) legal framework and provider’s responsibilities to people and their decisions were followed accordingly.

Staffing levels were reviewed and supported people to stay safe and well. People and staff told us there were enough staff to support people. The registered manager scheduled the visits and oversaw timings and length of visits. People and relatives were informed about the changes to their visits or the staff being late.

People, their families and other people that mattered were involved in the planning of their care. However, the care plans did not contain information specific to people’s needs and how to manage any conditions they had. This meant staff did not always have detailed guidance for them to follow when supporting people with their needs. This could put at risk of receiving inappropriate and unsafe care and support.

One person and a relative said they felt safe when staff were supporting them. They could approach the registered manager and staff with concerns. The registered manager had a process to deal with complaints, but they said they had not had any yet. Staff felt they could approach the registered manager and they communicated well in regard to the service and any related matters.

The management team was working with the local authority to investigate ongoing safeguarding cases. There was an emergency plan in place to respond to unexpected events. Staff had ongoing support via regular supervision and appraisals. They felt supported by the registered manager and other staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 26 March 2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to quality assurance; safeguarding management; record keeping; management of medicine; staff training and competence and recruitment. We have made a recommendation about meeting the Mental Capacity Act legal framework.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.