Generixcare Luton

Generix Care is a domiciliary care service providing personal care to people in their own homes. 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 the inspection the service was supporting 60 people, 55 of whom received personal care.

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

People and their relatives told us that care staff were sometimes late or did not stay for the agreed amount of time. This led to some people feeling rushed and other people feeling anxious. Some people were put at risk of not receiving safe care as a result of this. For example, some people said they went too long between meals, were left at risk of developing pressure ulcers due to staying in bed for too long or received time critical medicines late.

People also said that some new and agency staff were not well trained and did not have the skills to provide safe care. The provider was aware of this and was taking action to address the induction of new staff and improving access to face to face training for all staff including agency staff.

Although risks to people’s health and wellbeing were assessed, guidance to staff about how to support people safely was not detailed enough to ensure consistently safe care. Not all staff understood what a risk assessment was, where to find one or how it related to their work.

Some people were not confident that staff were skilled in administering medicines and gave examples of where errors had been made. Although staff were trained in medicines administration, we found checks made to assess their competence following the training were not always robustly carried out.

Although staff received training in safeguarding people from harm or abuse, staff understanding of types of abuse, signs to look out for and processes for reporting concerns was not strong. The provider had not always reported incidents to the care quality commission in line with regulatory requirements.

Systems to monitor the delivery and quality of care were not always used effectively to identify where improvements to the service were needed. However, where the provider had identified areas for improvement, plans were in progress to take action to address shortfalls.

Measures were in place to manage the risks of COVID-19 including policies and risk assessments. Staff told us they had access to sufficient Personal Protective Equipment (PPE) and had received training on how to keep themselves and others safe from the risks of COVID-19.

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.

The service worked well with other health and social care providers to ensure people received appropriate care, and when shortfalls to this occurred, the provider was proactive in taking swift action to address this.

The registered manager used the views of people who used the service, their relatives and staff to learn and make improvements to 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 Good (published 17 January 2019)

Why we inspected

We received concerns in relation to care call management, staff skills and practice, risk management in relation to COVID-19 and incident reporting. 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 have found evidence that the provider needs to make improvement. Please see the safe 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.

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 a breach in relation to the impact on people of late and shortened care calls, lack of accuracy, detail and awareness of risk assessment and shortfalls in staff skills and knowledge at this inspection.

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

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.

This announced comprehensive inspection took place between 5 December 2018 and 21 December 2018.

Following the last inspection in August 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-led to at least good. At this inspection, we found they had improved the areas we had previously been concerned about. However, Well-led was again rated ‘requires improvement’ because further improvements were required to the deployment of staff to improve the timeliness of care visits and people’s overall experience of the service. They needed to ensure that systems in place to improve this were effective to enable them to achieve this quickly.

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 2008 and associated Regulations about how the service is run.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or harm. There were now safe staff recruitment processes in place and there were sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. Staff had regular supervision and they had been trained to meet people’s individual needs effectively. The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when urgent care was needed.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice.

Staff regularly reviewed the care provided to people with their input to ensure that this continued to meet their individual needs, in a person-centred way. The provider had an effective system to handle complaints and concerns. Improvements were made in response to concerns raised by people. However, further work was necessary to ensure staff knew how people wanted to be supported at the end of their lives.

The provider did not have effective staff recruitment processes in place to ensure that people were always supported by staff who were suitable for their roles. There were missing references, and a risk assessment had not been completed when information of concern was highlighted in one member of staff’s Disclosure and Barring Service (DBS) report.

Some of the records were not up to date which meant that information was not always kept in an accessible manner. Although the provider completed audits, they did not have robust systems to drive continual and sustained improvements.

We found these were breaches of regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People were safe because the provider had systems to keep them safe from risks of abuse and harm, and staff had been trained on how to safeguard people. There were risk assessments in place so that staff knew how to support people safely. Where required, people had been supported safely to take their medicines. There was sufficient numbers of staff to support people safely.

Staff received training, support and supervision that enabled them to provide appropriate care to people who used the service. People were able to provide verbal consent to their care and support, and the requirements of the Mental Capacity Act 2005 were being met. Where required, people had been appropriately supported to have enough to eat and drink, and to access health services.

Staff were kind and caring towards people they supported. They treated people with respect and supported them to maintain their independence as much as possible. People were happy with how their care was being provided, and they valued the support they received from staff and the registered manager.

People’s needs had been assessed before they were supported by the service. Care plans took account of their individual needs, choices, and information received during assessments. Staff were responsive to people’s needs and where required, they were working closely with people’s relatives to ensure that the support they provided was appropriate. The provider had a system to manage people’s complaints and concerns, and concerns raised by people had been managed appropriately.

The provider worked closely with people, their relatives and staff to ensure that the service provided appropriately met people’s needs. They also promoted a caring and inclusive culture within the service.