Hibiscus Domiciliary Care Agency

Updated 25 August 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was conducted by 2 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 houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. There was an acting manager, who was overseeing the service until the recruitment of a new registered manager.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 7 June 2023 and ended on 15 June 2023. We visited the location’s service on 7 June 2023.

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. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people about their experience of the care provided. We also spoke with 4 staff, the manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records, these included 10 people’s care records, medicines administration records, as well as governance and quality assurance records. We also looked at 8 staff recruitment files.

Updated 25 August 2023

About the service

Hibiscus Domiciliary Care Agency is a domiciliary care agency providing personal care to people in their own homes. The service provides support to older people, people with dementia or mental health needs and those who may have physical or sensory disabilities. At the time of our inspection there were 11 people receiving support with personal care.

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

Systems used to monitor the quality of care people received were not always effective at identifying areas of concern. Audits had failed to identify some concerns with the administration of medicines, inconsistent information about people’s mental capacity, unsafe moving and handling practices, and out of date information in people’s care plans.

People were not supported to have maximum choice and control of their lives and staff did not support 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 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 were people using the service who have a learning disability and or who are autistic.

People's needs were met by sufficient numbers of staff. Recruitment checks were now in place. Staff followed infection control guidance to reduce the risk of cross infection. Where incidents occurred reviews now took place to reduce the likelihood of reoccurrence.

Staff now received relevant training and felt supported in their role. People’s needs had been assessed and staff understood their risks, as well as preferences. Risks associated with eating and drinking had been assessed and staff worked with other professionals to ensure people’s health needs were met.

The management team had undertaken training to develop knowledge appropriate for their roles. People and staff had been asked for their views on the service provided. People, staff and professionals spoke positively about 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 and update

The last rating for this service was inadequate (published 3 January 2023). We imposed conditions on the provider’s registration and 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 although some improvements had been made the provider remained in breach of regulations.

At our last inspection we recommended the provider should ensure the wording in care records was personalised and dignified. At this inspection we found the provider had acted on the recommendation and had made improvements to people's care plans and records.

Why we inspected

We carried out an announced comprehensive inspection of this service on 7 and 30 September 2022. 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 managing risks to people, the safe management of medicines, infection control, lack of governance systems, lack of training for staff, poor recruitment practices and failure to display their previous inspection rating. There was also a breach about supporting people to make decisions and following the Mental Capacity Act 2005.

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.

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 inadequate to requires improvement. 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 Hibiscus Domiciliary Care Agency on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to consent and good governance at this inspection. Please see the action we have told the provider to take at the end of this 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 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.

The overall rating for this service is ‘requires improvement’. However, the service remains 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.