Peak Care Homecare

Peak Care Homecare is a homecare and extra-care service which provides personal care. The service provides support to older people, this also included a person with a learning 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 21 people using the service and 17 of these people were supported with personal care.

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

The provider did not always follow their own policies and procedures. Staff did not always receive up to date training to ensure safe and effective care for people. Staff did not always receive formal supervisions of their performance and development. Following concerns being raised by inspectors, the provider took action to ensure training took place where needed and supervisions were booked for staff.

People did not have ‘as needed’ medicine protocols in place and people’s medicine administration was not always recorded in line with best practice guidance. Following this being raised by inspectors, the provider ensured systems were put in place for staff to record medicine administration safely and ‘as needed’ protocols were put in place.

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; however, systems in the service did not always support this practice.

People and relatives told us they felt safe using the service. Risks to people were assessed safely and people were protected from avoidable harm. Staffing levels and recruitment were safe. There was evidence of learning lessons when things went wrong.

People’s needs were assessed effectively. Staff worked with other agencies to support people. People were supported to maintain their nutrition and hydration.

People and relatives felt the service was person-centred and staff were supported by the management team. The management team was approachable for people, relatives and staff and feedback about the service was sought regularly.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was one person using the service who had a learning disability.

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 10 April 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received about management and provider oversight at the service. A decision was made for us to inspect to include the key questions of safe and well-led to examine those risks.

Following concerns found during the inspection with systems and processes around the Mental Capacity Act, a decision was made to also open the inspection to the domain of effective.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of the full report.

You can see what action we have asked the provider to take at the end of this full report. The provider sent evidence to us of some effective actions they took to mitigate these risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Peak Care Homecare on our website at www.cqc.org.uk.

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 a breach in relation to management and leadership at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

People’s experience of using this service:

Improvements were needed to ensure all information about people’s care was available within the office. Where people started to receive support, care plans needed to be developed in a timely manner. Quality monitoring systems needed to be developed further to review the care people received when living in their own homes in the community.

The staff understood how to protect people from harm and were confident that any concerns would be reported and investigated by the registered manager. Some people received assistance to take medicines and records were kept to ensure that this was done safely. There were safe recruitment procedures in place to ensure new staff were suitable to work with people.

Staff were supported and trained to ensure that they had the skills to support people effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People could make decisions about how they wanted to receive support to ensure their health needs were met. When people required assistance to eat and drink, the provider ensured that this was planned to meet their preferences and assessed need.

People had a small team of staff who provided their support and had caring relationships with them. Care was planned and reviewed with people and the provider ensured that people’s choices were followed. People’s privacy and dignity were respected and upheld by the staff who supported them.

People’s care was reviewed to reflect any changing needs. There was a complaints procedure in place and any concerns received were investigated and responded to in line with this policy.

People were asked for their feedback on the quality of the service and their contribution supported the development of the service. The registered manager promoted an open culture which put people at the heart of the service.

Rating at last inspection: Our last inspection report was published in June 2016 and the service was rated as Good.

Why we inspected: This was a planned inspection.

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

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

People said they were happy with the care they received at the service. One person said, "The staff are very good. Nothing would persuade me to leave my apartment here.'

We found that people's consent was obtained for their care, and the provider knew what procedures to use if they could not make their own decisions, for example due to dementia.

We saw people's needs were assessed and plans were in place about their care. Although staff were knowledgeable about people's needs, care plans did not always contain information to ensure people received care that met their needs, for example about any health conditions. We saw that assessments were not always in place to help protect people from risks.

At the time of our inspection staff were being recruited and sufficient numbers of staff were available to meet people's needs.

We found some systems were in place for assessing and monitoring the quality of the service but these were not fully ensuring people were protected from risks. The provider told us improvements were planned for when the new manager was in post.

We found that people's privacy, dignity and independence were respected. One person told us 'I am always treated with respect and the carers always know what care I need.'

We found people experienced care, treatment and support that met their needs and protected their rights. One person told us the service 'is very good, actually excellent: a very nice place with well appointed accommodation.' We found people's care and support needs had been thoroughly assessed and care was delivered in a way that met people's needs and ensured their safety and welfare.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

The provider had effective recruitment and selection processes in place.