Archived: Grace House Outreach Care

Grace House Outreach Care is a domiciliary care agency providing personal care to people living in their own homes. Two people were receiving care at the time of the inspection.

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

We received positive feedback from people and their families on the quality of the care they received. We were told that the staff and management team were caring, professional and delivered care the way people wanted.

Risks to safety had been assessed and measures were in place to reduce risk. Care plan were person centred and gave staff guidance on how to support people as per their care preferences.

Staff were safely recruited. People told us staff were appropriately trained and skilled.

We were told that the management team were responsive and accommodating.

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

Rating at last inspection

The last rating for this service was good (published 8 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Grace House Outreach Care is run by the Christian Care Trust, who also operate a residential care home called Grace House. We inspected Grace House on the 30 September 2020 and this service was also inspected at the same time.

This inspection was a focused inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led. The overall rating has remained Good. This is based on our findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grace House Outreach Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service. If we receive any concerning information we may inspect.

After the inspection, the provider wrote to us to say what they would do to meet legal requirements. We undertook this comprehensive inspection on 18 July 2017 to check that the provider had followed their plan and to confirm that they now met the legal requirements relating to the two breaches of regulations.

The provider is registered to provide care to people in their own homes. The provider has informed us that the service specialises in the care and support of older people and people living with dementia. At the time of this inspection they were providing a regulated care service to two people in their own homes. They were providing additional services to other people such as domestic support; however, those are not services that we regulate.

The service had a registered manager, which is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found that the provider had followed their plan and legal requirements had been met. Monthly governance reports were now being sent to us as required. They demonstrated suitable oversight of care management of the service. This meant that the provider was checking that people were receiving good care. The principles of the Mental Capacity Act 2005 had now been embedded into the service’s care planning process and the care that people received. This meant that staff knew to seek people’s consent before providing care and to ensure decisions were made in their best interests if they could not consent.

People using the service and their representatives praised the service highly and told us they would recommend it to others. They told us of patient and caring staff, and that their views were respected.

There were enough staff for people to receive visits as planned, and there was good continuity of staff, which helped trusting relationships to develop.

People received care and support from appropriately trained staff who received good support for their care roles. People were supported to eat well, maintain good health, and take medicines as prescribed.

Staff could demonstrate a respectful and attentive approach. People’s independence was promoted. Their care plans had been reviewed and updated to ensure they remained accurate.

People were protected from abuse by effective safeguarding procedures. Actions were taken to minimise safety risks.

This service had been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We undertook this comprehensive inspection to check on the progress made by the provider, and to consider whether the service could be removed from Special Measures, our framework to ensure a timely and coordinated response where we judge the standard of care to be inadequate.

Following the last inspection, we also took enforcement action. We imposed a condition on the provider's registration requiring them to send us monthly audit reports about people’s care plans and risk assessments, recruitment checks, records security, and staff supervision, and what action was being taken to address any risks identified in those audits. The condition took effect on 10 October 2016; however, at the time of drafting this report, we had received no such reports. This failure to send the required reports demonstrated ineffective governance, and in conjunction with our findings at this inspection, influenced our regulatory decisions.

The provider is registered to provide homecare services to anybody in the community. The provider has informed us that the service specialises in the care and support of older people and people living with dementia. At the time of this inspection the agency was providing a regulated care service to two people in their own homes. It was providing additional services to other people such as domestic support; however, those are not services that we regulate.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People using the service and a relative provided good feedback about the service’s care and attentiveness. We found that the service was caring and respectful.

A management consultant had been recently hired to assist with implementing service improvements. We saw their input, including the guidance of staff on appropriate care practices, as progress towards addressing our concerns.

However, we found insufficient improvement in the management of the service. Whilst criminal record checks (DBS) were now in place for established staff, recruitment checks of new staff were still not completed before the staff member started providing care to people. Audits of those checks were additionally inaccurate.

Risk management processes were still not comprehensive at ensuring that all reasonable actions were taken to minimise risks to people using the service. People’s care plans had not been reviewed recently enough to ensure that they were up-to-date. This all had potential to undermine appropriate and safe care practices.

Whilst staff had understanding of the Mental Capacity Act 2005 for their work, the service had not embedded the principles of this Act into people’s care planning records.

People received care and support from appropriately trained staff. The service supported people to maintain good health and eat well. There was continuity of staff, which helped trusting relationships to develop, and people always received their care visits as planned.

People were encouraged to raise concerns informally, which the service responded to. The service also helped people to be part of the local community and avoid social isolation.

There were overall two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, there was not enough improvement to take the provider out of ‘Special Measures.’ CQC is now considering the appropriate regulatory response to resolve the problems we found.

The provider is registered to provide homecare services to anybody in the community. The provider has informed us that the service specialises in the care and support of older people and people living with dementia. At the time of this inspection the agency was providing a regulated care service to six people in their own homes. It was providing additional services to other people such as domestic support; however, those are not services that we regulate.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People using the service and their relatives generally provided good feedback about the service. They said the staff supplied were caring, attentive and provided the support needed in a friendly and kind way. We found that the service was caring.

The service provided sufficient numbers of staff so that people received their care visits as planned. Staff benefitted from regular training, particularly the new National Care Certificate which is a set of minimum standards that staff should uphold in their daily working life and which new staff must be trained on.

However, we found some significant concerns about how the service was operated that particularly undermined people’s ongoing safety. Criminal record checks and appropriate references were not in place for a number of newer staff, meaning the provider had not taken necessary steps to ensure that these staff were safe to work with people alone in their homes.

Risk management processes were not comprehensive. They did not ensure that all reasonable actions were taken to minimise risks to people using the service. Whilst efforts were made to address people’s needs in practice, people’s care plans did not consistently address all their support needs and sometimes contained contradictory information. This had potential to undermine appropriate care practices.

We also found concerns with how well-led the service was. There were few recorded governance systems in place, and so we identified shortfalls that the management team and the provider had not recognised or addressed. The service had not embedded the principles of the Mental Capacity Act 2005 into its practice. There were shortfalls in how securely information about people using the service and management records were stored.

There were overall six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the registered provider and the registered manager. We will report further on this when it is completed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection, we found that matters had been addressed. There were now consistent records of the care provided to each person in their home. There was written evidence that environmental risk assessments had taken place for the care to be provided in people's homes. People's care files were up-to-date and their needs were regularly reviewed.

Staff were now receiving training to help update their skills, for example, on food hygiene, safeguarding, and dementia care. We found that systems of supervising staff had been implemented. Staff were being supported to provide people with safe and appropriate care.

We found that the provider now had systems to regularly assess and monitor the quality of service that people received. We were shown how people's comments were being used to improve the services provided. There was also evidence that the views of staff were being sought, to help make service improvements.

We found that people experienced care that met their needs and protected their rights. People were also protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

However, we found that the provider did not have suitable staff training, supervision and appraisal arrangements in place to ensure that care was delivered to people safely and to an appropriate standard.

We found ineffective management audit tools to assess and monitor care quality, and identify, assess and manage risks relating to the health, welfare and safety of people. This failed to protect people against the risks of inappropriate or unsafe care.

We also found that accurate records were not always maintained. This included the records of care provided to people, records of staff supervision, and visit rosters. This put people at risk of failing to receive care that was safe and to an appropriate standard.

We are taking action to ensure the provider becomes compliant with the regulations.

Everybody told us care workers and senior staff treated them with respect, and listened to and acted on their views and preferences. 'They always ask if there's anything else they can do before they leave,' one person told us. People praised the care workers supplied by the agency. 'Staff know what they're doing,' said one person.

We found, however, that accurate records about the services provided to people, including up-to-date risk assessments and records of care provided, were not always maintained. This put people at risk of failing to receive care that was safe and to an appropriate standard.