Background to this inspection
Updated
24 August 2022
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 carried out by one inspector 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 service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
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 15 July 2022 and ended on 21 July 2022. We visited the location’s office on 15 July 2022.
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. 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 nine family members about their relative’s experience of the care provided. We spoke with the registered manager when we undertook the site visit. We spoke with four care staff by telephone.
We reviewed a range of records. This included two people’s care records and two people’s medication records. We looked at four staff files in relation to recruitment. A variety of records relating to the management of the service and quality monitoring
Updated
24 August 2022
About the service
Cynosure Health Care Ltd. is a domiciliary care agency providing personal care and support 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 our inspection there were 12 people using the service.
People’s experience of using this service and what we found
Systems and processes to monitor the quality of the service and ensure people’s safety were not effective. Audits undertaken did not provide guidance for their completion. Audits had failed to identify that the provider’s policies and procedures were not always followed and that improvements were needed.
The policy for the safe management of medicines was not followed. Records used to record the medicine people were prescribed and its administration were not completed in full. Decisions made in people’s best interests in relation to their medicine were not fully documented and did not provide clear guidance for staff.
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 required improvement to ensure best interest decisions were supported by clear guidance for staff.
Family members told us staff were kind and caring. They spoke of the positive impact staff had on their relative’s day to day life. A family member told us, “I can hear chuckles and laughing, it is so nice when they [staff] are cooking and are asking what my relative wants for dinner.”
A family member told us how their relative’s cultural needs were met by staff who had learned to prepare culturally appropriate meals. They told us, “Staff are very good. I wish you could see how patient staff are. Staff have learnt how to cook Jamaican food.”
Potential risks were assessed, and people’s care records provided information for staff as to how to reduce risk and provide safe care. People were cared for by staff who had been assessed as to their suitability to provide care, and who had been provided with training to promote safety and meet people’s needs. Staff were aware of their role and responsibilities in reporting concerns about people’s safety and welfare.
Family members spoke positively as to the quality of care provided and good communication between themselves, care staff and office-based staff, which included the management team.
People’s views as to the quality of the service were sought. Staff were supported to undertake their role, which included supervision and by attending staff meetings. The registered manager liaised with other professionals and organisations to share information and improve the service provided.
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 Good (published 5 March 2019).
Why we inspected
We received concerns in relation to staff recruitment and training. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.
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 Good to Requires improvement based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cynosure Health Care Ltd., on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 and will take further action if needed.
We have identified breaches in relation to the management of medicine and the effectiveness of auditing to monitor the quality of the care provided 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 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.