All About U Care Services Ltd

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

The service had been supporting the same person for many years. Care was person-centred and safe. However, there had not been a registered manager in place since 2021. This reflected the registered provider’s lack of understanding of their regulatory responsibilities. The registered provider was in the process of applying to become registered manager.

Since our last inspection, new quality checks had been put in place. They were practical and supported safe care. However, quality checks and training programmes remained limited to the needs of the person being supported.

There was room to improve written risk assessments and care planning. However, we found minimal impact as the person received support from a small staff team who knew their needs well.

Communication across the service was effective and open, with good involvement with the person’s relative and external professionals.

There were enough staff to meet the person’s needs. Staff knew how to support the person from the risk of abuse. The registered manager and staff supported the person and their family to manage risk. The person received their medicines as prescribed. Staff supported the person to minimise the risk of infection.

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.

Right Support:

The person was supported by staff to have a fulfilling and meaningful everyday life.

Right Care:

Staff members knew the person well and communicated with them in a kind and compassionate manner.

Right Culture:

The whole service focused on the wellbeing of the person being supported.

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 July 2021). The registered manager completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

We undertook a focused inspection to review the key questions of safe and well-led only. We reviewed whether improvements had been made since our last inspection.

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

Recommendations

We made recommendations around improved checks, training, care plans and risk assessments.

Follow up

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

All About U Care is a domiciliary care agency which supports adults with personal care. At the time of the inspection the service supported one person.

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

At the time of the inspection the registered manager was not available and had been absent from the service for over a year. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

In their absence, the director or the company was supporting staff and had taken on responsibility for the day to day management of the service. Whilst we received positive feedback from staff about the support they received from the director, they had not fully understood their responsibility to meet regulatory requirements and improvements needed to be made to the systems used to monitor the quality and safety of the care provided.

New staff were safely recruited. We have made a recommendation about the renewal of DBS checks for existing staff.

Accidents and incidents were recorded. However, further work was needed to evidence lessons learned and the action taken to reduce the risk of reoccurrence.

Staff had completed safeguarding training and knew how to raise concerns internally and with external organisations.

Staff were provided with appropriate PPE and we were assured staff used this when supporting the person using the service.

Risk assessments were person centred and identified areas where staff needed to support the person in their daily life.

People who use this service 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.

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. Staff provided person centred care which promoted people’s dignity, privacy and human rights.

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 9 December 2017).

Why we inspected

We received concerns in relation to safeguarding’s and the prolonged absence of the registered manager. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 identified breaches in relation to the lack of effective systems to monitor the quality and safety of the service 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 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.

The inspection was announced and took place on 25 October 2017 with follow up phone calls to staff and people who used the service on 27 October 2017. We gave the service 48 hours' notice that we would be inspecting as we needed to be sure that the registered manager would be available. At the time of inspection there was a registered manager in post. 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 had risk assessments and management plans in place which provided guidance to staff on how to provide care in order to prevent or minimise the risk of people coming to harm. However, these assessments were generic and did not always identify and record specific risks to each individual.

We made a recommendation that the provider review their risk assessment and recording process.

The current system for monitoring late or missed visits by care staff was not robust. The provider agreed to review their system for monitoring care visits to ensure the safety and wellbeing of all of the people who used the service.

People who required support with medicines were assisted by staff who were trained and assessed as competent to give medicines safely. However, recording practices were inconsistent and improvements were required to demonstrate that people had received their medicines as prescribed.

We made a recommendation that the provider review their system for recording and auditing people’s medicine administration records.

People were protected from harm by staff who understood their safeguarding responsibilities. Staff recognised the signs of abuse and knew what action to take if abuse was suspected. Staff were aware of the whistle-blowing policy and felt confident to raise concerns if necessary.

There were systems in place to ensure the safe recruitment of staff and sufficient numbers of staff were deployed to safely meet people's needs.

Staff received an induction and ongoing training to equip them with the knowledge and skills to care and support people effectively. Observations were carried out to monitor and assess staff competency.

Staff felt well supported and received bi-annual appraisals of their practice. Supervision was provided to staff by the registered manager but this was informal and had not been documented.

We made a recommendation that the provider review their current method of supervising staff.

The service supported people to make choices and exercise control over their lives. People’s family members or representatives were included in the decision-making process where appropriate.

Where people were assisted at mealtimes, they were supported to have enough to eat and drink which reflected their preferences and met any health needs. The service liaised with health and social care professionals when concerns were raised about people's health and wellbeing.

Staff were kind and caring, knew people well and treated them with dignity and respect. The service adopted a person-centred approach and care was tailored to meet people's individual needs. People were involved in the care planning process and in decisions about their care and treatment.

There were systems in place to support people to make a complaint or raise concerns about the service. Feedback from people who used the service was sought and acted upon to improve the service people received.

Staff enjoyed working at the service and felt well supported by the management team who they found approachable and accessible.

The registered manager was ‘hands-on’ and completed checks on the quality and safety of the service on a daily basis. However, these audits were not documented so the service could not reliably be monitored.

We made a recommendation that the provider review their quality assurance systems and processes to ensure more robust oversight of the service.

All about U care services Ltd is a community based service providing home care support for people living in their own homes. At the time of this inspection, there were 18 people using the service.

The service has a registered manager in place. 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.

There were some risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. However these did not cover all areas of risk.

The provider had recruitment processes in place but there was not always sufficient staff to support people. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who they said knew them well. Staff also said that they were given the opportunity to get to know the people they supported. Relatives we spoke with described the staff as pleasant and lovely. However due to shortage of staff the provider could not always respond to people’s needs.

People’s needs had been assessed, and care plans took account of their individual preferences, and choices. Staff supported people when required to attend health care visits such as GP appointments and hospital visits.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.