Independent People Homecare

Updated 17 November 2021

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 Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of three inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

This inspection was announced. We gave the provider notice of the inspection so that inspectors and the expert by experience could begin to make telephone calls to people and staff before inspectors attended the providers offices. Inspection activity started on 22 September 2021 and ended on 27 September 2021. We visited the office location on 27 September.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information providers are required to send us with key information about the service, what it does well and improvements they plan to make. We took this into account in making our judgements in this report.

During the inspection

We spoke with fifteen people and their relatives about their experience of the care provided. We spoke with nineteen members of staff including the provider, registered manager, deputy manager, consultant, training manager, live-in care manager and support workers.

We reviewed a range of records. This included seven people’s care records. We looked at eleven staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including training records, policies and procedures were reviewed.

Updated 17 November 2021

About the service

Independent People Homecare is a domiciliary care agency providing support to people in their own home. The service provides live-in care support and care calls in the community. At the time of inspection, they were providing support to 73 people.

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.

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

We received mixed feedback about the service. Generally, people were happy with the support they received from their regular live-in care workers. However, they were less satisfied when relief care workers were in place.

In addition to providing live-in care workers to people, the provider was delivering a community service where staff supported people with calls for short periods throughout the day, to help them with personal care or medication.

The registered manager and provider did not follow their policy to promptly notify the local authority of service failure. Leading to people going without their required care calls and placing them at risk of neglect. We found the registered manager and provider had not escalated potential safeguarding concerns to the relevant local authorities to investigate.

Risk assessments did not always contain all the information needed to support people safely. Where risk assessments were in place we found processes put in place to mitigate risks were not always followed.

Medication was not always managed safely, when care calls had been missed, we could not be assured people had received their medicines as prescribed.

We were not assured that the provider learnt lessons when things went wrong. The provider had identified the need to implement an electronic call monitoring system following an episode of calls being missed. However, at the time of inspection this had not been implemented.

The provider needed to improve the governance systems they had in place to ensure effective oversight of all aspects of the service. Monitoring of safeguarding and financial records needed to improve.

Staff received supervision and were supported with training in person and on-line to equip them with the skills they needed to support people.

People were mostly satisfied with the support they received with eating and drinking from their regular live-in care staff. People were supported to access other healthcare services such as GPs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. We did find that some best interest decisions needed to be more detailed and less generic.

People were more positive about the care they received from care workers who supported them consistently in comparison to relief care workers. Care plans reflected people needs in a person-centred way. However, some relatives told us when care plans were reviewed they did not always contain accurate details.

The provider and registered manager had systems in place to manage complaints, however they did not always escalate concerns to the appropriate safeguarding authority when complaints were related to poor care.

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

Rating at last inspection and update

The last rating for this service at the previous premises was Inadequate (report published 9 December 2020) and there were multiple 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 inspection we found improvements had been made. We have identified breaches in relation to safeguarding, safe care and treatment and good governance. This is because safeguarding concerns were not always raised and responded to promptly, medication was not always managed safely, learning was not implemented from previous failures, and governance systems were not safely underpinning the service.

This service has been in Special Measures since 9 December 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The inspection was prompted in part due to concerns received about people going without calls, missed medication, staff not being trained, lack of PPE and staff not having disclosure and barring checks. A decision was made for us to inspect and examine those risks. Additionally, notification of a specific incident prompted the inspection. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

We have found evidence that the provider needs to make improvements. Please see the full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.