About the service: SQ Carers Limited is registered to provide personal care to people living in their own homes, including older people and people living with dementia. At the time of our inspection visit, the service supported 21 people. People’s experience of using this service:
We last inspected SQ Carers Limited in May 2018 when we rated the service as 'Requires Improvement' in Safe, Caring, Responsive and Well Led, together with a breach of the regulations. At this inspection we found key questions of ‘Safe', 'Responsive' and 'Well-led' remain 'Requires Improvement' and there are continuing breaches of the regulations, with one new breach.
The registered manager and compliance manager completed regular audits and checks on the quality of the service. However, shortfalls found at this and the previous inspection in May 2018, had still not been addressed.
The registered manager had not ensured they had effective systems to manage care calls and call timings, to people’s preferred choices. Their action plan following the last inspection said this would be rectified by 2 July 2018, however, improvements were not made. Most people continued to tell us they did not receive their care calls when they wanted. People knew what to do if they had a concern or complaint, but in two cases, people said when they had raised concerns about the call timings, nothing had changed. They did not feel listened to or that their opinions mattered.
There was a system in place to manage risks associated with people’s care needs, however some assessments did not always provide staff with consistent information to manage those risks. In addition to this, staff were not consistent in their recording and monitoring of some people’s needs. There was a potential for changes in people’s physical and emotional wellbeing not be identified.
Safe recruitment policies were not followed. Five out of six staff recruitment files failed to evidence necessary employment checks on people’s character, fitness and ability to support vulnerable people, because they were not completed. The provider failed to follow their own recruitment policies and procedures.
People said they were confident in the staff's skills and abilities to look after them and keep them safe.
People's needs were assessed before they started using the service to make sure staff could deliver the care that they needed. People and relatives said they had agreed to the care and support they received. Care plans were not all up to date and did not include person-centred information.
Most people and relatives said staff were kind, compassionate and caring and took their time to carry out their duties and did not rush. However, some people said staff had limited time with them and when concerns had been raised, they felt no action had been taken to reduce their anxieties.
Most people self-administered their medicines or had relatives to help them. Where staff supported with medicines, records showed risks of error where kept to a minimum.
People were supported people to access health care professionals when they needed them. The staff worked with other agencies to provide joined up care.
Staff followed safe infection control practices.
Care and support was given in line with legislation and guidance, such as following the principles of the Mental Capacity Act 2005. People's personal information was still accessible on staff’s personal mobile telephones, although less information limited potential for unwanted sharing of personal information.
We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:
Regulation 17 Regulated Activities Regulations 2014 - Good governance
Regulation 19 Regulated Activities Regulations 2014 – Fit and proper persons employed.
Rating at last inspection: Requires Improvement (The last report was published on 16 June 2018).
Why we inspected: This was a planned inspection based on the rating at the last inspection on 16 May 2018 where we found the provider was in breach of Regulation 17 of the Health and Social Care Act, (Regulated Activity) Regulations 2014, (Good Governance). We returned to do a comprehensive inspection to follow up on this breach and to ensure, the provider had improved other areas of their service to at least Good. At this inspection, we found the provider continued to be in breach of the regulations which had a negative impact on other key areas of their service.
Enforcement (include only where applicable): Action we told provider to take (refer to end of full report).
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk