Kris Carers Ltd

Kris Carers Ltd is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our inspection there were 42 people using the service.

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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

People and relatives were mostly satisfied with the service, and some said it had improved. The provider had new systems in place to check the care and support provided was of good quality. Some changes were needed to the service’s registered service user bands to ensure people’s needs could always be met.

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.

Right Care:

Staff provided safe care and knew how to protect people from harm. They followed people’s care plans and risk assessments which were personalised. Some improvements were needed to medicines records.

People and relatives made many positive comments about the caring nature of the staff. Staff were safely recruited. They told us they enjoyed working for the service and were well-supported by the registered manager and other senior staff.

Right Culture:

People and relatives said managers and staff listened to them and made changes where necessary. They had the opportunity to complete quality assurance surveys which were used to improve 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 and update

The last rating for this service was Inadequate (published 28 November 2022). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 28 November 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced comprehensive inspection of this service on 11, 12 and 26 October 2022. Breaches of legal requirements were found and a Warning Notice served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook this focused inspection to confirm the provider now met legal requirements.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. 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 Inadequate to Requires Improvement. 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 Kris Carers Ltd on our website at www.cqc.org.uk

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kris Carers is a domiciliary care agency, providing personal care to people living in their own homes. At the time of our inspection, 90 people were using the service. They all received support with personal care.

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

People were not always kept safe from the risk of abuse. Care plans did not provide guidance on people’s physical and mental health needs. This lack of guidance can impact staff’s ability to keep people safe. Health care professionals were contacted when people were unwell, however there was not always a written record of their involvement and advice. P People’s medicines were not supported safely. There were enough staff, however staff were not always recruited safely. This was because they had started working with people before their background had been checked. Poor quality recording and analysis meant lessons were not always learnt when things went wrong. People were kept safe from the spread of infection.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible and in their best interests. Systems in the service did not support good practice. People received enough to eat and drink. Staff had received training to complete their role, however some feedback and findings suggested this training was not sufficient to enable effective care.

The oversight of the service meant people may not always receive kind and caring support. This is because the registered manager did not always respond to safeguarding allegations, and staff had begun work before their background had been checked. However, people and relatives spoke highly of individual staff kindness.

Care plans provided detail on people’s life history and beliefs. No one at the service was currently at the end of their life, however pro-active discussions had not occurred to discuss people’s end of life wishes if their health deteriorated.

The governance and oversight at the service was poor quality. In June 2022, the local authority audited the service and found concerns. These concerns were ongoing at this inspection. When we raised specific examples to the registered manager, a lack of action had been taken a week later. This poor oversight and action taken when risks were raised, left people at ongoing risk of poor-quality care.

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 18 November 2021)

Why we inspected

The inspection was prompted due to concerns we had received from the local ambulance service. We had also received an allegation that a person had been moved without using suitable equipment and had been force fed by staff. The local authority safeguarding team had investigated this allegation and found the provider’s response to this allegation was poor quality. Due to this, a decision was made for us to complete a focused inspection and examine the safety and governance at the service. While completing the focused inspection, we identified some further concerns at the service. We therefore decided to widen our inspection scope and complete a fully comprehensive inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of the report. These sections describe what breaches of regulation have occurred. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kris Carers 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 and will take further action if needed.

At this inspection, we have identified breaches in relation to safe care, safeguarding, fit and proper persons deployed, consent, and governance.

Full information about CQC’s regulatory response can be found at the end of the 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Kris Carers is a domiciliary care agency, providing personal care to people living in their own homes. At the time of our inspection 69 people were using the service who all received support with personal care.

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

People and relatives told us that staff were not always on time for their visits. The service was aware of this through their quality monitoring processes and had put several measures in place to address this.

People received safe, planned care. The registered manager had systems and processes in place to safeguard people from harm and abuse. Staff understood the importance of reporting accidents and incidents. The registered manager monitored and reviewed these and took appropriate action to reduce any risks.

Peoples’ medicines were managed safely and administered by trained and competency checked staff.

People were protected from the risk of infection, staff took part in regular testing for COVID-19 and people confirmed staff always wore the required personal protective equipment (PPE) when visiting.

Staff had completed mandatory induction training prior to delivering services to people and the registered manager had identified and sourced additional training for staff when this had been required.

People’s care plans identified their eating and drinking needs and specialised dietary requirements were highlighted for staff to follow. People food and fluid intake was monitored when appropriate.

The registered manager understood the importance of monitoring the quality performance of the service. There were systems and processes in place which regularly provided this information including the monitoring of call times, medication and care record audits. This information was monitored and actioned appropriately.

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

The last rating for this service was requires improvement (published 15 May 2021).

Why we inspected

The inspection was prompted in part due to concerns received about medicines and meeting people’s nutritional and hydration needs. 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.

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.

Kris Carers Limited is a domiciliary care service based in Leicester. The service provides care and support to people living in their own homes. At the time of the inspection there were 54 people using the service.

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

There were risk management plans in place to help keep people safe. However, we found some areas of identified risk such as the risk of malnutrition did not have a risk assessment to ensure staff supported people safely. Risk assessments had not always been reviewed regularly or when people's needs changed.

There were quality checks in place to audit and review records and systems, however these were not always reliable and effective. For example, the quality monitoring checks had not identified gaps in the risk management plans for people and risks were not always identified.

We received feedback about poor communication with some staff due to language barriers. There was no system in place to assess staff English language proficiency and communication skills to ensure people's needs were fully met.

Care plans were detailed and provided staff with good guidance on how to support people safely.

There were systems and processes in place to safeguard people from potential harm. All the people we spoke with told us they felt safe when receiving care. Staff completed training about safeguarding people from harm and knew how to report abuse.

There were sufficient numbers of staff to meet people's needs safely. We saw on the staff rotas that staff had sufficient travel time. There were systems in place to monitor calls and to ensure staff stayed for the correct amount of time. The provider had followed their recruitment practices to ensure people employed were suitable to work at the service and support people.

Medicines were managed safely, and people told us they received their medicines as prescribed. There was a comprehensive medicines policy in place and staff competency was checked regularly to ensure they could administer medicines safely.

There were systems in place to prevent the spread of infection. Staff had access to sufficient PPE and people we spoke with said staff always wore their PPE when they provided care. Staff had completed training in relation to Infection control and Covid 19.

There were systems in place to ensure lessons were learned and improvements made when things went wrong.

There was a complaints procedure in place and improvements had been made to ensure all complaints were recorded and dealt with in line with the providers complaints policy.

Staff felt well supported by the registered manager and the management team. They described them as approachable and responsive. Staff, people using the services and relatives were encouraged to provide feedback which was analysed and acted upon to drive improvements.

The service worked in partnership with outside agencies.

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 31 May 2019). The service remains Requires Improvement. This service has been rated Requires Improvement for the last two consecutive inspections.

The provider completed an action plan after the last comprehensive inspection to show what they would do and by when, to make improvements.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to staff not wearing Personal Protective Equipment (PPE), staff not staying for the agreed time and poor communication with staff due to language barriers. 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 remains Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kris Carers 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.

Kris Carers Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of this inspection 42 people using the service received personal care.

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

The provider had made some improvements in how it monitors the quality of service. Further action was still needed to fully embed the quality monitoring systems, ensure the training for staff and the registered manager was kept up to date and the requirements of duty of candour were fully understood.

Commissioners continue to work with the office staff to develop person centred care plans and to improve the systems used to monitor the people’s care.

People and relatives told us they were happy with the care provided. Staff were mostly reliable and on time. Staff told us they felt supported by the office staff. The views of people who used the service and staff were sought.

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 requires improvement (published 31 May 2019).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook a focused inspection to review the Key Questions of Well-led only.

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

Follow up

We will continue to monitor information we receive about the service. 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:

¿The governance system used to monitor quality of service remained fragmented and there were failings as a result of this.

¿The registered manager, who is also the provider, was not open and transparent in relation to complaints and concerns in line with the Duty of Candour.

¿ People told us the service was not well managed. The registered manager was not always available or responsive and there was an over reliance on the office staff to manage the service on a day to day basis.

¿Staff supported people with their medicines, but records were not always completed to confirm this.

¿ Staff recruitment procedure was not always followed to protect people from unsuitable staff.

¿ There were enough staff to support people. However, staff were not always reliable or on time to meet people’s needs.

¿ The system to ensure staff were trained for their role was not sufficiently robust. Training was not monitored, and some staff training was overdue in areas such as mental capacity and safeguarding people from abuse. Staff were supported individually, and their practices were checked.

¿ People not confident that their complaint would be addressed. Records showed the complaint procedure was not followed and improvements were limited.

¿ People’s care files showed risk were assessed and managed in a safe way.

¿ People told us they felt safe and protected from discrimination. Staff knew what abuse looked like and the action they should take.

¿ People were not always involved in the reviewing of their care to ensure they received person centred and responsive care as their needs changed.

¿ People’s dietary needs were assessed. Staff prepared meals and drinks where required.

¿ People were supported to access health care services as required.

¿ People’s rights to make their own decisions were respected. Mental capacity assessments were completed as required. Staff sought consent before care was provided.

¿ People’s diverse needs were met.

¿ People’s wishes about their end of life was not always documented.

¿ People were supported by kind and caring staff.

¿ People’s privacy and dignity was protected. People’s independence was promoted by staff.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published June 2018).

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection. At that inspection the domains of safe, effective, responsive and well led were rated as requires improvement.

Enforcement: Action we told provider to take (refer to end of full report).

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality 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

At the last comprehensive inspection on 25 and 28 October 2015 the service was rated Good.

This is the second comprehensive inspection of the service. This took place on 9 and 10 April 2018 and was announced. At the time of our inspection 50 people were receiving care.

At this inspection the service had deteriorated to ‘Requires Improvement’.

The provider and registered manager had not consistently met the regulatory responsibilities. They had not provided us with the key information about the service when required, which we took into account when making judgement about the service.

The registered manager had not fully understood and met all the legal requirements with regards to their registration. The provider had moved to new premises but had failed to submit the relevant notification and applications to maintain their registration. The registered manager had not accessed relevant training to maintain their knowledge about the changes in legislation and best practice. The registered manager assured us they would access training.

Following our inspection visit the provider submitted relevant notifications and applications ensure they were registered correctly.

The provider had not notified the Care Quality Commission of significant events as they are required to do. The provider's system to monitor the quality of care provision was not in place. Some internal checks were carried out but they did not drive improvements. Policies, procedures and guidance for staff did not reflect current professional guidance and best practice.

Where people required support with their medicines, staff had been trained in the safe handling of medicine. However, we found some gaps in the medicine administration records. These had been identified by the registered manager and staff received further training and records were monitored.

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. However, information in the care plans about how to support people to make decisions was not always clearly recorded. The frequency of reviewing people’s care varied and care plans were not always updated to ensure staff had guidance to support people. The registered manager assured us they would address the issues raised.

People continued to receive safe care. People needs were assessed and they continued to be involved in the development of their care plan. People continued to be protected from avoidable risks. A range of risks assessments were completed and preventative action was taken to reduce the risk of harm to people. People were supported to maintain good health and nutrition.

People continued to receive effective care and support. Staff recruitment processes were followed and ensured that people were protected from being cared for by unsuitable staff. There were enough staff to provide care and support to people to meet their needs safely. Staff continued to receive a range of training for their role and to protect people from avoidable harm. Staff understood their responsibilities to work effectively. Staff practices were checked regularly and when required additional training and support was provided.

People continued to receive good care. Despite the quality of information in people’s care plans staff knew people well and how to support them. They had developed positive relationship with the staff who understood their needs. Staff were kind, caring and treated people with dignity and respect.

Care plans and relevant information was made available in accessible formats to help people understand the care and support agreed. Staff worked in a flexible way and took account of people’s diverse and cultural needs to ensure continuity of care was promoted.

People knew how to raise a concern or to make a complaint. The provider had a complaint policy and procedure and complaints received were investigated.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

Another relative told us that the care records were good and that care staff were punctual and did everything they were meant to do. They added 'everything was perfect when they left the house'.

Relatives we spoke with told us they considered that the care staff kept their relatives safe. One added that the care staff service 'made a lot of difference and they cheer us both up. They are really kind and thoughtful'.

We found that the service regularly monitored and reviewed the service they provided to ensure that people were supported safely.