Serenity Always Health Care

Serenity Always Health Care is a domiciliary care service that provides personal care to people living in their own homes. 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 the service was providing personal care support to 9 people.

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

People were not always supported on time by staff as staff did not have enough traveling time between people's care calls. People were supported by trained staff however staff's understanding of safeguarding and the MCA could be improved. Quality assurance tools had not identified concerns we found around staff rotas and training.

People felt safe and were supported by safely recruited staff. People had care plans and risk assessments in place which explored their needs and preferences. Staff knew people well and were meeting their needs. People were supported to receive their medicines as prescribed. People were supported in line with infection control guidance.

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; the policies and systems in the service supported this practice. People were supported to eat and drink in line with their needs and preferences. People had end of life care plans in place.

People were supported to access health and social care professionals where they required these. People were supported by staff they described as 'caring' and 'kind'. People were supported to maintain their privacy and dignity. People were supported to maximise their independence.

People and their relatives knew how to complain. The provider responded promptly to concerns raised about the service. The provider had quality assurance tools in place in relation to medicines and care plans which identified where improvements were required and took action to make improvements.

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 was requires improvement (published 18 March 2021). At this inspection we found improvements had been made but the rating remained requires improvement. The service has been rated as less than good on four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the management and oversight of the service. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the well led section of this full report.

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.

At this inspection we made recommendations around staff training in relation to safeguarding.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Serenity Always Health Care is a domiciliary care service that provides personal care to people living in their own homes. At the time of our inspection the service was providing personal care support to six 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

Quality assurance systems had been introduced, however we had could not fully confirm they would be sustained and continually effective, as previous attempts had failed. There was an ongoing concern with one person’s topical creams that had not been addressed. As this was an ongoing concern, lessons had not always been learned when things went wrong. However, lots of other improvements had been made and other medicines for people were being managed safely.

Risks to people’s health and wellbeing were being assessed and planned for. However, staff supporting one person with distressed behaviours did not always have effective skills to know how to respond.

There were enough staff to cover calls and people were visited by the same staff. Staff were recruited safely, however we found one example where a criminal record had not been re-checked by the provider once the staff member had been appointed. Staff training compliance was now being monitored. People were protected from the risk of cross infection as staff followed personal protective equipment (PPE) and infection control guidance.

Care plans now contained more detail and were person-centred. People felt the service had improved and they were asked for their opinion. Feedback was given following surveys. There was a strong ethic of working in partnership with other health professionals.

The provider had made a long-term commitment to having support from an external consultant to support and monitor the service.

The registered manager was aware of their responsibilities about duty of candour. The provider was displayed their previous inspection rating as necessary.

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 requires improvement (published 23 October 2020) and there were two breaches of regulation. At this inspection improvements had been made so the provider was no longer in breach, but some further improvements were needed.

Why we inspected

We carried out an announced focused inspection of this service in September 2020. Breaches of legal requirements were found. The provider continued to provide us with an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement overall. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor the provider’s progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Serenity Always Health Care is a domiciliary care service that provides personal care to people living in their own homes. At the time of our inspection visit, the service was providing personal care support to eight 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

Quality assurance systems were not always effective at identifying areas for improvement and we could not be sure that measures introduced to monitor the service would be sustained. We could not always be sure people were kept safe when bruising had been found.

The assessment and management of risk to people had improved overall, however we found some areas which would benefit from further improvement. Lessons had not always been learned when things had gone wrong as there were still some areas to improve.

The management of medicines had improved but further improvements were needed. One topical cream was being applied by staff which was not prescribed, and this had not been identified. ‘As required’ medicine had guidance in place for staff to follow.

There were enough staff to cover calls. Staff were recruited safely, however we found one example where the documenting of employment checks could be more robust. People were protected from the risk of cross infection as staff followed the additional guidance in place due to the COVDI-19 pandemic.

People were having their decision-specific mental capacity assessed and decisions made in people’s best interests were now recorded. People had access to other health professionals and guidance was sought from people’s GPs. People were generally supported by family to eat and drink, however we found people were supported as appropriate in line with their needs. Staff received training to be effective in their role, had their competency checked and felt supported.

People and relatives were asked their opinion about the support they received. People, relatives and staff felt positive about the management of the service and improvements being made.

The registered manager was aware of their responsibilities about duty of candour. The provider was displayed their previous inspection rating as necessary and they worked in partnership with other organisations.

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 requires improvement (published 14 January 2020) and there were multiple breaches of regulation. The key question well-led was rated inadequate. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of some regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service in November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, consent and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement overall. This is based on the findings at this inspection.

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

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.

We have identified continued breaches in relation to safe care and treatment and governance at this inspection.

You can see the action we told provider to take at the end of the full report. 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Serenity Always Health Care is a domiciliary care service that provides personal care to people living in their own homes. At the time of our inspection visit, the service was providing personal care support to 15 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

Quality assurance systems had failed to effectively monitor and improve the quality of people’s care and ensure they were consistently safely supported. Checks that were in place were not being utilised correctly and there was no oversight of accidents, incidents or records about people’s care.

We could not be sure people were always being supported with their medicines safely. People were receiving their planned care calls; however, management staff were often having to cover so they did not always have time to manage the service. Risks were not always assessed and planned for. Lessons were not always learned when things had gone wrong as there was not always oversight of this.

People were not always having their decision-specific mental capacity assessed. Decisions made in people’s best interests were not being recorded. People had access to other health professionals, however additional clarification and guidance was not always sought in relation to some medical conditions. Staff had received some training but the ongoing monitoring of this was ineffective.

People had their care plans reviewed, however changes were not always made when necessary. People and relatives felt able to complain, but it was not always possible to see the outcomes of complaints.

No one was receiving end of life care at the time of the inspection, but the registered manager was aware of local organisations who could support them with this aspect of people’s care. People had their communication needs recorded and were supported to access information about their care.

Staff understood their safeguarding responsibilities and people felt safe. People were protected from the risk of cross infection.

People were supported to have enough to eat and drink. People felt they were treated with dignity and supported to remain independent. People were involved in decisions about their care.

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

Rating at last inspection

The service was rated inadequate overall. It was inadequate in all key question apart from caring with was rated as requires improvement (published 18 May 2019)

Why we inspected

This was a planned inspection based on the rating at the last inspection. We found ongoing concerns during this inspection and there were breaches in regulations. We rated the key question well-led inadequate. The key questions safe, effective, caring and responsive were rated requires improvement. The overall rating was requires improvement.

Enforcement

We have identified breaches in relation to poor oversight of the service, the safety of people’s support, assessing people’s ability to consent and complying with conditions on their registration.

You can see the action we told provider to take at the end of the full report. 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

The overall rating for this service is ‘Requires improvement’. However, we are keeping the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement 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. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

About the service:

Serenity Always Health Care is a domiciliary care service that provides personal care to people living in Wolverhampton and Telford, Shropshire. At the time of our inspection visit, the service was providing personal care support to approximately 50 people.

People’s experience of using this service:

People were not protected from the risk of harm. Risks to people were not being assessed and planned for and staff did not have guidance on how to care for people safely. The provider had not deployed safe systems of care to manage people’s medicines. Records of incidents and accidents were not kept and we could not be sure action was taken to reduce the risk of re-occurrence.

Staff could identify the signs of potential abuse and reported any concerns to the provider. However, the lack of incident records meant we could not be sure the provider had referred any concerns to the local authority safeguarding team when needed.

Staff had not received sufficient training or supervision to ensure they could deliver safe and effective care. The provider did not provide effective guidance for staff on the safe administration of people’s medicines, or monitor their practice to assure us that people received their medicines as prescribed.

We could not be sure people were supported in the least restrictive way possible. The provider did not follow legal requirements when people lacked the capacity to make certain decisions. People had not signed to consent to their care and were not always consulted on how they wanted to receive their care. Care plans were not personalised and did not reflect people’s diverse needs. The provider was not identifying and meeting the information and communication needs of people with a disability or sensory loss.

There was a lack of oversight of the service and the provider had not developed a systematic approach to quality assurance to identify shortfalls and drive improvements. People and relatives knew how to complain but did not always feel confident their concerns would be listened to or acted on. The provider had sought feedback on how the service could be improved but could not demonstrate that this was acted on.

Staff treated people with kindness and respect, but sometimes felt staff were rushing to finish their care and did not always have time to provide emotional support. There were not enough staff to meet people's needs and keep them safe at all times. The provider needed to recruit additional staff to ensure they could respond to unplanned absences. The provider followed recruitment procedures to ensure staff were suitable to work with people.

People were supported to access health care services when they needed to and staff ensured people had choice when they supported them with meals.

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

Rating at last inspection:

The service was rated as Good in all key questions (published 10 December 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found concerns during the inspection and there were breaches in regulations. We rated the key questions safe, effective, responsive and well led as Inadequate. The key question caring was rated Requires Improvement. The overall rating was Inadequate.

Enforcement:

You can see the action we told provider to take at the end of the full report.

Follow up:

As we have rated the service as inadequate, the service will be placed in 'special measures'. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider's registration of the service, it 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, so that there is still a rating of inadequate for any key question or overall, we will act 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.

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.

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.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People felt safe. Staff understood their responsibilities in identifying and reporting potential abuse. Risks had been assessed and were managed with the aim of protecting people from avoidable harm. The provider had systems in place to ensure only suitable staff were recruited to work with people. People received their medicines as prescribed with support from trained staff.

People and their relatives told us staff had the skills and knowledge required to meet their needs. Staff received training relevant to their role. People were asked for their consent before care and support was provided. People who received support to maintain their diet were happy with the food and drink provided. Staff knew how to respond to changes in people’s healthcare needs and people were supported to access relevant healthcare services when required.

People and their relatives told us the staff who supported them were friendly and caring. People were supported to make their own decisions about their care and support. Staff supported people in a way that upheld their privacy and dignity and where possible, promoted independence.

People and their relatives were involved in the planning and assessment of their care and support. People were supported by staff who understood their needs and preferences. People knew who to contact if they were unhappy about the service they received. There was a system in place to manage complaints and people received details of how to complain, when they started using the service.

People, relatives and staff told us they were happy with the service and told us they felt it was well managed. Staff felt supported by the registered manager and provider and were able to share their views, ideas and concerns. There were systems in place to monitor the quality of the service provided and people had been asked to give feedback about the service they received.