Snowball Care UK Ltd

Snowball Care UK Ltd is a domiciliary care agency providing personal care to people living in their own homes. The service supports people over 65 years old, people with a learning disability and autistic people. At the time of our inspection there were 95 people using the service.

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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: Staff supported people to make care and support decisions that met their individual needs and abilities. Staff knew people well and understood how to meet their individual needs. Care records were written so people could understand their support and helped them to make informed choices about the care they received. 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.

Right Care: People received good quality care and support. Staff were kind and respected people’s choice. Staff provided care and support, so people's privacy and dignity were maintained. Staff understood abuse and safeguarding and how to protect people from the risk of harm. Staff were trained and skilled to meet people's individual care and support needs.

Right Culture: People received good quality care staff who understood their needs. People, relatives and people who were important were involved in the assessment and reviews of care and support. The registered manager monitored the quality of care to ensure the service was of a good standard. Lessons were learnt from previous incidents and action had been taken to improve the quality of the service.

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

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this was inspected but not rated, (published, 1 June 2022). The previous focused inspection was requires improvement (published, 11 May 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. Please see the Safe, Effective and Well-led sections of this full report.

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

Follow up

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

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

People gave positive views about the care workers that visited them and of the quality of care they received. Comments we received included, told us, "They’re [care workers] all very kind. I know them well” and “They are all very kind and considerate.”

Risks to people were assessed and reviewed when changes in their health or care needs occurred. We found that risks related to people’s health, safety and well being including their individual mobility needs were assessed. Plans to mitigate those risks were in place providing staff with guidance to manage these safely. We saw these records had been updated and reviewed to ensure they reflected people’s current needs.

Staff understood the provider's safeguarding policy and the procedures to follow to keep people safe from harm. The provider's safeguarding processes was understood and followed by staff to ensure allegations of abuse were managed safely. The staff Code of Conduct was reviewed ad updated and provided staff with information on how to act in an emergency or if they suspected abuse.

The provider had a recruitment policy and process that was used to employ suitable staff. Staff records contained pre-employment checks to ensure they were safe to work with people.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was requires improvement (7 May 2020).

Why we inspected

We were prompted to carry out this inspection due to information of concern we received about risk assessments and the plans to mitigate any concerns or risks. We also received some information of concern regarding recruitment practices of newly employed staff. We decided to carry out a targeted inspection to examine those risks.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections cannot change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

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

Snowball Care is a domiciliary care service providing personal care to 77 older people and some younger people with physical health needs at the time of the inspection.

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

The provider had appropriate systems in place to identify and mitigate risks to people’s health and safety. There were clear systems in place to identify, report and investigate allegations of abuse. There were enough suitably qualified and appropriately vetted staff to work with people. The provider supported people with their medicines safely. There were appropriate infection control measures in place and care staff had enough Personal Protective Equipment (PPE) to do their jobs. There were clear systems in place to deal with accidents and incidents.

The provider worked in line with current legislation, for example the Mental Capacity Act 2005 and staff were given the support they needed to do their roles. People were supported to meet their health and nutrition needs.

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 and their relatives gave good feedback about the service. The registered manager and other members of staff understood their responsibilities. The quality of care was appropriately monitored through effective quality assurance systems and people were asked for their views about the running of the service.

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 21 November 2019).

Why we inspected

We carried out an announced comprehensive inspection of this service on 16 and 17 September 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 meet the regulations in relation to safe care and treatment, the governance of the service, person- centred care, the need to consent the employment of fit and proper persons and staffing.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Safe, Effective and Well-led key questions which were previously rated requires improvement

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. Although the provider has taken appropriate action in relation to the breaches of regulation previously found, we were unable to change the rating as we have not seen consistently improved practice over a sufficient period of time.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People were not always protected from the risk of harm as the provider was not conducting clear risk assessments in relation to people’s health and safety. We could not be assured that lessons were being learned following accidents and incidents as the provider was not keeping clear records of these. People did not have clear medicines care plans in place which stated the medicine they were supposed to be taking, the time and the dose. The provider had not always obtained a full employment history from staff before hiring them to work, but was conducting other pre- employment checks.

The provider was not effectively supporting staff because they were not ensuring they received regular training and supervisions. The provider did not have clear, personalised care plans in place which included details of people’s health needs and conditions, their preferences and views in relation to their care, their religious or cultural needs, support needed to maintain their independence, their end of life care needs, their communication needs and their social needs.

The provider was not aware it was their responsibility to assess people’s capacity to consent. There was therefore a risk that care would be provided that was not in line with people’s valid consent. The provider was not consistently providing care in line with current legislation and their own internal policies and procedures and was not appropriately assessing people’s needs and choices.

The provider was not improving the quality of care because they were not auditing various areas of the service and did not fully understand their duties, responsibilities and regulatory requirements. The registered manager was not aware it was her duty to send notifications of safeguarding incidents to the CQC or that it was her responsibility to ensure people’s capacity had been assessed.

The provider ensured there were enough staff working at the service and they had enough time to support people. Care workers had good infection control practices. The provider worked with other agencies to ensure they received professional advice and support when needed. Care workers respected and promoted people’s privacy and dignity. Complaints were handled appropriately. The provider conducted surveys of care to obtain people’s feedback and people and staff told us there was a positive culture within the service.

People were not supported to have maximum choice and control of their lives and we were not assured that staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We have made a recommendation about producing person- centred care plans.

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 17 March 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We have identified breaches in relation to safe care and treatment, staffing, personalised care, consent, and good governance at this inspection.

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.

Snowball Care UK Limited is a domiciliary care provider people. At the time of the inspection the service was providing support to 84 people. People receiving support included older people and people with a learning disability.

The service had a registered manager at the time of the inspection. 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 2008 and associated Regulations about how the service is run.

Staff were trained to keep people safe and report any suspicion of abuse. The likelihood of people experiencing avoidable harm was reduced because the manager assessed people’s risks and developed plans to mitigate them. There were sufficient numbers of vetted and safely recruited staff to deliver care and support as planned. Staff provided people with the support they required to take their medicines safely.

People received care and support from trained, skilled and knowledgeable staff. People received the support they required to eat and drink. Staff supported people to maintain their health and access healthcare professionals as their needs required.

People received care from staff who were caring. Staff supported people to make decisions and maintain their independence. People’s privacy was respected and their dignity was promoted. People received support from consistent staff enabling positive relationships to develop.

People had their needs assessed and reassessments were also carried out when people’s needs changed. People’s care was delivered at times they choose and the service provided bi-lingual staff to meet people’s cultural and communication needs. People shared their views with the provider about the care they received and complaints were dealt with appropriately.

The service had a registered manager who was a qualified social care professional. There was an open management style at the service. The provider undertook checks and audits to monitor service delivery and drive up improvements.