We carried out a review of the data available to us about Caring Circle Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Caring Circle Limited, you can give feedback on this service.
Hidmat Care Ltd is a domiciliary care agency providing personal care and support to people in their own homes. 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 39 people who received packages of support which included personal care.
People’s experience of using this service and what we found
Further improvements were needed to ensure effective quality assurance checks of some key areas of the service. The registered manager had good practical oversight of the running of the service and was aware of the improvements needed. During the inspection they introduced new processes and created an action plan to prioritise and track progress.
Since the last inspection improvements have been made to risk assessment and care planning processes. People received safe care which was assessed, monitored and regularly reviewed.
Improvements had been made to recruitment checks undertaken before people commenced work. People received care and support from a consistent staff team as far as possible. Carers normally arrived on time and stayed for the correct length of time.
When people required support to take their medicines, assessments set out people's needs and preferences. Staff followed good infection prevention and control practices and used personal protective equipment (PPE) including masks and gloves.
Accidents and incidents were recorded and followed up appropriately. Lessons were learned and shared when something went wrong or an area for improvement was identified.
Care plans included information about people's support needs and preferences. Staff received an induction and training for their roles.
Where required, people were supported with their eating and drinking needs. The management team worked with health and social care professionals to maintain people's health and welfare.
Staff understood and followed the principles of the Mental Capacity Act and sought consent, offered choice and supported people make decisions about their care.
The registered manager was well thought of and available, confirmed in feedback from people, relatives and staff. People were confident any arising problems or issues would be resolved in a timely manner.
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.
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 requires improvement (published 13 November 2020) and warning notices were issued to give the provider a short time to make improvements in the areas of people’s safe care and treatment and governance of the service. Since then we undertook a targeted inspection to follow up on those specific issues, but that inspection did not give a rating (published 29 May 2021). There continued to be breaches of regulation in the same areas.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns received about call times and the length of visits. A decision was made for us to inspect and examine those 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 requires improvement to good. 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 Hidmat Care 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.
Hidmat Care Limited is a domiciliary care agency. It provides care for people living in their own houses and flats. People are supported in their own homes so that they can live as independently as possible. CQC regulates the personal care and support. There were 30 people using this service at the time of our visit.
People’s experience of using this service and what we found
At our previous inspection we found that care records did not contain sufficient information and guidance to enable staff to support people in a safe way. At this inspection, we found that some improvements had been made to care planning and risk management systems, but further improvement was still needed.
People’s safety was not always ensured because risk management was not always in place for falls, pressure area care, catheter care, diabetes management.
At the last inspection we found the provider did not always follow their recruitment policies and procedures to ensure staff were recruited safely. At this inspection we found some improvements had been made but there were still several staff employment references which had not been obtained. Improvements had been made with staff training records but staff were not always fully trained to provide effective care.
Improvements had been made within medicines management, recording and regular auditing of medicines was taking place. However, there was further work to do on medicine which was prescribed to use 'as required'.
We found that staff communication had improved and spot checks were beginning to take place to ensure staff they were competent in their roles.
Accidents and incidents were analysed and action taken where necessary.
Rating at last inspection
The last rating for this service was Requires Improvement (published 12 November 2020). There were breaches in Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that sufficient improvements had not been made and therefore they remain in breach of these regulations.
Why we inspected
CQC have introduced 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 do not 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 Hidmat Care Limited 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.
Hidmat is a domiciliary care agency, providing personal care to 31 people 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 and what we found
Care records did not contain sufficient information and guidance to enable staff to support people in a safe way. Risk management was not always in place for falls, pressure area care, catheter care, diabetes management and the use of oxygen.
The provider did not always follow its recruitment policies and procedures to ensure staff were recruited safely.
It was unclear if staff had received adequate training for their roles. The training records were out of date and there were gaps in some staff training records.
There were no recent audit of medicines management and some staff competencies in medicines were out of date.
Some staff training in infection control and prevention was out of date
The service had sufficient numbers of staff, but there was a lack of supervision and spot checks on staff performance.
Governance arrangements did not provide assurance that the service was well-led. The provider had not ensured that their systems and processes to monitor the quality of care was effective. The provider had not ensured the service had a registered manager in place.
There was a lack of analysis of incidents and it was not clear that lessons were learned, and improvements were made when things went wrong.
Positive feed-back was received from people and their relatives about the service and its staff. Staff were positive about the service and the support from the management team.
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 Requires Improvement (published 21 July 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We received concerns in relation to recruitment processes and incident management. 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 remained 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 this report.
You can see what action we have asked the provider to take at the end of this full report.
During the inspection the manager took immediate steps to address our concerns and make immediate improvements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hidmat Care Ltd on our website at www.cqc.org.uk.
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 monitor the service.
We have identified breaches in relation to poor risk assessment and a lack of quality monitoring of the service.
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.
Since the last inspection we recognised that the provider had failed to ensure there is a registered manager in place at the service. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.
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.
People’s experience of using this service:
People’s needs associated with risk had been assessed, but not fully explored to ensure staff had sufficient guidance to support and manage any known risks. Recruitment processes were not robust enough to ensure people employed were safe to work with the people who used the service. Where people required medicine, this was administered as prescribed, but the provider did not always follow their administrating medicines policies and procedures. People and their families felt safe with the staff that cared for them. Safeguarding systems were in place. People were protected from cross contamination because staff followed infection control policy and procedures. Systems were in place to monitor Incident and accidents.
Care plans were not consistent with information of people’s needs. Staff were knowledgeable about the people they cared for. However, when they cared for people living with a condition, such as, dementia or required specific use of equipment, such as, a catheter, pressure stockings or specific foot wear, the care plan lacked instruction how staff should care for these people. This was a recording issue. Protected characteristics under the Equality Act 2010, were considered when identifying people’s needs and preferences, such as, preferred language if their first language was not English. People consented to their care and support, but where they lacked capacity, mental capacity assessments for decisions they needed to make, or decisions made in their best interest were not fully completed.
Staff attended an induction and training relevant to their role, but lacked specific training in conditions such as, dementia. People were supported to eat and drink according to their culture, religion and preferences. The provider worked with other professionals and implemented recommendations to help achieve a positive outcome for people’s health and wellbeing.
People were cared for by kind, compassionate and caring staff. People had an opportunity to discuss their care and support on a regular basis. Advocate support was acquired if people needed support to express their views. People were shown respect and their dignity was protected always
Care was planned and personalised, but not always consistent in the way people wanted. Systems were in place to monitor and address complaints. End of life care plans needed development. This was discussed at team meeting and training was to be identified.
There was a registered manager in post and they had an oversight of the service, which they planned to develop and improve further. The registered manager was open and transparent to all shortfalls we found at the inspection. Audits and quality checks were completed. People were involved in discussions about their care and support. Staff felt supported by the registered manager and confident to raise issues and concerns. The provider worked with other professionals and developed networks within the community.
Rating at last inspection: Requires Improvement (Published 16 January 2018 ).
Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw sufficient improvement had not been made since the last inspection. This meant the service still required improvement. This is the second consecutive time this service has not received a rating of Good.
Follow up: We have asked the registered provider to send us an action plan telling us what steps they are taking to make the improvements identified as needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services. For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Hidmat Care Limited has been registered with the CQC since 31 January 2016; however they did not commence providing the regulated activity of personal care until 10 October 2017. Prior to this inspection we received some information of concern which meant we inspected this service earlier than we had planned to. We concluded during the inspection that the information we had received was not substantiated and we completed the first full inspection of this service since it had become registered with the CQC.
At the time of the inspection Hidmat Care Limited supported five people who received some element of support with their personal care.
Staff had not always been recruited safely. Some staff had received training in the safeguarding of adults but some staff were in the process of completing this training. Some of the risks to people’s safety had been assessed although some lacked specific detail about the people assessed needs.
People told us they felt safe when staff were in their home. People required minimal support from staff with their medicines, however where needed, medicine administration records were not always appropriately completed. Some staff had received infection control training and assessments of the environment people lived in were carried out to ensure they were safe.
People felt staff supported them effectively their physical, mental health and social needs. The registered manager had an awareness of current legislation and best practice guidelines. Not all staff had completed the required training to carry out their role; however, staff were in the process of doing so. People received minimal support with their meals and where staff support was needed this was done so effectively. The registered manager told us they would work with other health and social care agencies, when the need arose, to ensure people’s health needs were regularly monitored and transitions to other services were effective. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice, however clearer documentation was required to ensure all decisions made clearly evidenced that they were in each person’s best interests.
People felt staff were kind, caring, respectful and treated them with dignity and respect. People felt able to make decisions about their care and support needs and were confident their views would be acted on appropriately. Staff had formed positive relationships with people and people’s diverse needs were respected. People were encouraged to do as much for themselves as possible. People were not currently provided with information about how they could access independent advocates.
People felt staff communicated well with them and felt confident when they raised any issues with the office based staff that these would be acted on. People were treated equally, without discrimination and their personalised preferences were recorded in their support records. The registered manager had limited knowledge of the Accessible Information Standard; however some efforts had been made to ensure people with communication needs and/or sensory impairment were treated equally. People felt able to make a complaint and were confident it would be dealt with appropriately.
This is a new service that is led by a registered manager and provider who are keen to improve the quality of people’s lives, ensuring people’s human rights are respected and to gain people’s views and to act on them. The registered manager acknowledged there were improvements needed but assured us these would be addressed. People and staff spoke highly of the registered manager and felt they were approachable and interested in what they had to say. The quality assurance processes that were in place were not yet working effectively to help identify the concerns raised within this report.