Glee Care Ltd

Glee Care Ltd is a domiciliary care service. The service provides care and support to people living in their own homes in the community.

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 16 people were receiving personal care.

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

Staff provided people with individual support in line with their assessed needs. However, the support plans viewed during the inspection required more detail to reflect the actual support being provided. No people had come to harm, and the provider arranged for the support plans to be updated with the additional information.

Most people and relatives spoken with during the inspection expressed they were pleased with the care and support they received from the service. However, some people expressed that poor time keeping was a problem they encountered with the service. The provider confirmed that in response to feedback from people using the service around timekeeping they had improved the electronic care monitoring system, to track when staff arrived and left each care call. The provider had also held staff meetings to stress the importance of staff contacting the office when running late, so people could be informed, and if needed, alternative arrangements made.

People and their relatives knew how to raise a complaint and said they would feel confident to do so. Records showed the provider had responded to complaints. Feedback we received from a relative that had raised some concerns with the provider, indicated their concerns had not been dealt with appropriately. This had the potential to make people reluctant to challenge unsafe or unacceptable practice for fear of recriminations. The provider said they had learnt from the event and welcomed critical feedback, which was used to drive improvement of the service.

People received support from staff that were suitably recruited. Staff received induction training and on-going refresher training to keep their knowledge and skills up to date. All people and relatives commented they received support from a core group of staff, who understood their needs and preferences.

Where the provider took on the responsibility, people were supported with their medicine’s by staff that had received training on medicines administration and had their competency to safely administer medicines assessed.

People felt reassured and safe as staff followed government guidance on COVID-19. Staff followed infection prevention control (IPC) best practice, in relation to reducing the risks of infection spread, wearing personal protective equipment (PPE) and following good hand hygiene. Staff had access to enough supplies of PPE equipment.

People told us the provider was open and welcoming and led by example. Staff told us they felt respected, valued and supported. Staff spoke positively of the support they received from the provider who often worked alongside them on care calls.

The provider understood their legal obligations. CQC had been informed about events they were required to by law, and they had displayed the last inspection rating on their website and within the service as required.

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 04 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received regarding time keeping, staffing and the governance of the service. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-Led sections of this full report.

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 of Good has not changed based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Glee Care Ltd 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following our inspection in November 2016, the service was rated as inadequate and placed in Special Measures. When we inspected the service in June 2017, we found some improvements had been made, but further improvements were required. The provider and registered manager had not been communicating openly with people and their relatives in a consistent and transparent way. This had led to misleading information being shared with one person about which registered service was providing a person's care and support, which was in breach of the Regulations. The service remained in Special Measures, because the lack of transparency reported under the key line of enquiry, well-led, had an impact on the ratings across all the key lines of enquiry.

The provider had not displayed their inspection rating from their November 2016 inspection, which was also a breach of the regulations. This was a continued breach of the governance of the service. The service remained in special measures because ‘well-led’ remained rated as ‘inadequate’.

The lack of transparency had meant there were breaches of the Regulations related to safety and consent, which resulted in ratings of requires improvement in safe, effective, caring and responsive. The provider had not conducted risk assessments for one person, had not obtained their consent to care, had not demonstrated a caring attitude, through their lack of transparency, and had not explained their terms and conditions, including how to make a complaint. This had resulted in ratings of requires improvement in safe, effective, caring, and responsive.

At this inspection we found the provider had taken action to improve. The provider had checked that everyone who used the service knew who their provider was. They had issued contracts to everyone and people or their representatives had signed their consent to receive care and support from this provider. They had implemented regular checks with everyone who used the service, to make sure they were happy with the how their care was delivered. They had regular meetings with everyone who used the service and invited them to feedback about any changes needed, or any concerns with the quality of the service. The provider had displayed their ratings at their office and on their website. The service is no longer in breach of the regulations and the rating for well-led is now good. The service has been taken out of special measures.

The registered manager had been registered with us since June 2016. 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 protected from the risks of harm or abuse because staff were trained in safeguarding and understood their responsibilities to raise any concerns with the registered manager. The registered manager had recruited enough suitably skilled, qualified and experienced staff to support people safely and effectively.

People and their relatives were included in planning how they were cared for and supported. Risks to people’s individual health and wellbeing were assessed and their care was planned to minimise the risks. People were supported to maintain their health.

The manager ensured staff had the necessary skills and experience to support people safely and effectively. They observed staff’s practice, arranged for them to attend regular training and supported them to obtain nationally recognised qualifications in health and social care.

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 supported this practice.

People, relatives and staff felt well cared for. Staff understood people’s diverse needs and interests and supported them to enjoy their lives according to their preferences. Staff respected people’s right to privacy and supported people to maintain their independence.

People and relatives had no complaints about the service. People and relatives knew the provider and registered manager well and were confident to share their views of the service through conversation and meetings with either of them.

The provider checked the quality of the service to make sure people’s needs were met safely and effectively. They understood that their personal, professional development enabled them to improve and develop the service.

Further information is in the detailed findings below.

Glee Care Limited, Nuneaton is registered to provide personal care and support to people living in their own homes. The director of Glee Care Limited, who we refer to as the provider in our report, told us they did not currently have any people that used their service who lived in Nuneaton, Warwickshire. The provider told us they had three people that used their service in Leicestershire. During our inspection, we found there were four people using the service at the time of our inspection.

A requirement of the provider’s registration is that they have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider’s they are ‘registered persons.’ Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. At the time of our inspection there was a registered manager in post who was also the provider; with their husband who was director of Glee Care Limited. Both the registered manager and director told us they also undertook most of the care visits to people that used their service.

The service was last inspected in November 2016. We found the provider had not made the required improvements identified to them at an earlier inspection, which was undertaken at their previous office site, (February 2016) and continued to be in breach of the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In November 2016, we rated the service ‘inadequate’ and placed them in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

We met with the provider to discuss our concerns and have since kept the service under review. We notified the local authority commissioners about the serious concerns we had found that related to the safety and quality of care that people received. The provider was asked to submit an urgent action plan to us to tell us how they were going to mitigate risks to people, which they did.

Following our November 2016 inspection, the local authority told us they were no longer commissioning services for people from the provider, and the provider told us they had no people using their services. In March 2017, the provider contacted us to say they had a small number of people now using their service. At this inspection, we checked on the improvements that had been made.

At this inspection we found insufficient improvements had been made to remove the service from special measures. We found continued breaches of the regulations that related to people’s safe care and in the governance of the home. The provider and registered manager had not always openly communicated with people and their relatives in a transparent way which had led to misleading information being shared about which registered service was providing a person’s care and support. This was a continued breach of the governance of the service. The provider had not displayed their inspection rating from their November 2016 inspection which was a breach of the regulations.

At this inspection, we were not able to assess some parts of the key questions we ask. This was because at the time of our inspection people receiving care and support from the provider’s service, did not require staff to support them, for example, with their medicines or food and drink preparation.

Improvements had been made to ensure staff were safely recruited and received an induction and training for their job role. Staff knew people well and how to meet their needs and worked in line with the requirements of the Mental Capacity Act 2005.

People and their relatives told us that staff were had a kind and caring approach to them when undertaking care tasks. Staff knew how to promote people’s independence and maintain their privacy and dignity. However, we found the registered manager and provider had not always been transparent with people or their relatives about which care provider was undertaking calls to them.

We found the registered manager and provider had not demonstrated a caring approach to one person in receipt of their care. This person had no care plan or risk assessments completed by the provider.

Most people had an individual plan of their care needs and knew who to contact if they had any concerns of complaints about the service they received. People told us they were happy with the care and support and staff arrived when expected.

Feedback was sought from most people from the provider as a part of their quality assurance procedures. There was a small staff team which felt supported by the registered manager.

The provider had not implemented all of their quality assurance systems and processes because they had only recently started to provide a service to people again. We were therefore unable to assess the effectiveness of audit processes.

You can see what action we told the provider to take at the back of the full version of the report.

Glee Care Ltd - Nuneaton is registered to provide personal care and support to people living in their own homes. The service operates across Nuneaton in Warwickshire. There were 12 people using the service at the time of our inspection.

A requirement of the provider's registration is that they have a registered manager. A registered manager is a person who had registered with the Care Quality Commission to manage the service. Like registered provider's they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. At the time of our inspection there was a registered manager in post who was also the provider for the service. The registered manager was supported by the company director to run the service. We refer to the registered manager as the provider in the body of this report.

The service was last inspected on 4 February 2016 when we found the provider was not meeting the required standards. We identified two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to establish appropriate systems to assess, monitor and improve the quality and safety of service provided. Also, implement systems to ensure staff had the skills and experience for the work they are required to perform.

The provider sent us an action plan which stated all the required improvements would be completed by 31 August 2016. During this inspection we found improvements had not been made and sufficient action had not been taken in response to the breaches in regulations.

The provider did not have sufficient systems and processes in place to assure themselves that people received a safe and good quality service that met their needs. We found risks associated with people's care were not always managed well to make sure people and care workers were protected from the risk of harm. We could not be sure the provider had sufficient knowledge of what constituted abuse because referrals were not always made to the local authority when safeguarding concerns were identified. Following our visit we spoke with the Local Authority about the concerns we had identified.

Care workers did not feel valued or supported by the provider to effectively carry out their role. The provider was not working in-line with their recruitment procedure to ensure suitable care workers were employed. This meant, we could not be sure people were kept as safe as possible. The induction process did not effectively support new care workers when they started work at the service. Care workers did not always receive the training they needed. We identified medication administration training was not effective. We could not be sure people received their medicines as prescribed because medication administration records were not completed correctly.

People told us care workers did not always arrive to provide their care and often care workers did not arrive at the times they expected them. This had a negative impact on people’s health and well-being. People’s experiences of being supported by consistent care workers were mixed. People who required support with eating and drinking did not always receive adequate support to meet their nutritional needs.

Overall, people told us that individual care workers showed them kindness and maintained their privacy. Care workers demonstrated they knew some of the people they cared for, and they spoke affectionately about them. However, people told us they did not always feel their dignity was maintained by the service they received and we received mixed feedback as to whether care workers treated people with respect.

People's care records were not always detailed and personalised to give new staff guidance on how people preferred their care and support to be provided. We could not be sure the provider had taken action to ensure people's wishes and preferences were identified, listened to and considered when delivering care.

People told us they were encouraged by care workers to make made everyday decisions for themselves, which helped to maintain their independence. The provider and care workers understood the principles of the mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had been completed for people who needed them. Care workers gained people’s consent before they provided care. This ensured people were looked after in a way that did not inappropriately restrict their freedom.

Overall, people and their relatives told us the leadership of the service needed to be improved. People knew how to make a complaint. However, people and their relatives did not feel their requests and complaints were listened to and acted upon. The system in place to manage complaints about the service was not sufficient. This meant we could not be sure all complaints had been responded to and investigated thoroughly.

We found a number of breaches of the Health and social care Act 2008 (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. Following our inspection we notified the local authority commissioners about the serious concerns we had identified related to the safety and quality of care that people received. We spoke with, wrote formally and then met with the provider to give them the opportunity to provide assurances of actions taken to ensure the safety of people. We asked them to submit an urgent action plan to tell us how they were going to mitigate the risks.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.