Preferred Home Care Services Limited

Preferred Home Care Limited is a Domiciliary Care Agency providing personal care to people in their own homes. At the time of our inspection there was one person being supported by the service. We have been unable to allocate a rating to some of our key questions to give an overall rating as there was insufficient information/evidence for us to form a judgement.

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

At this inspection, we found some improvements had been made since our last inspection in relation to the recruitment of staff and governance documents. However, there were still concerns about the management of the service.

The provider had not had a registered manager in post since the last inspection. We were told a new manager had applied for a Care Quality Commission (CQC) Disclosure and Barring Service check, but we could not find a record of this application being submitted. The provider had not informed the CQC of changes to the nominated individual. The nominated individual is responsible for supervising the management of the regulated activity provided. This was only changed when prompted as part of the inspection. The provider was not being transparent about their most recent CQC rating on their website, this was rectified following our inspection.

The provider had an action plan in place to drive improvements following the last inspection. New audits had been devised but we were unable to assess the efficiency of these audits due to the provider supporting one person with minimal care and support needs. Staff had pre-employment checks in place, but we could not always verify who the references were from.

The care manager was the only staff member delivering care and support at the time of this inspection. Other staff were employed by the provider but were not actively working. All staff received training to underpin their knowledge in health and social care.

Care plans and risk assessments were in place for one person supported by the service. A relative told us they found staff caring and kind and felt their relative was well supported.

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 16 March 2022) and there were multiple breaches of regulation. At this inspection we found some improvements, but the provider remained in breach of regulations.

This service has been in Special Measures since 16 March 2022. During this inspection there was insufficient evidence to give an overall rating and the well-led key question remains inadequate.

Why we inspected

This comprehensive inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 Preferred Home Care Limited 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 running of the service at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Due to having insufficient evidence to give an overall rating, the service will continue to be in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Preferred Home Care Services Limited is a domiciliary care agency providing personal care to people in their own homes. At the time of the inspection the service was providing care to six people.

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

The provider did not have systems in place to monitor the service and drive improvements. The management structure and the responsibilities of the management team were unclear. The service did not fully engage with the inspection process and did not provide all information, as requested. The registered manager resigned during the inspection process. There were no audits to demonstrate how the service was monitoring the quality of the service being provided. Records had not been accurately maintained or monitored to drive improvements at the service.

Risks relating to people’s care were not always fully assessed and care plans did not always reflect people’s needs. Incidents were not always accurately recorded or reviewed by the management. There was no evidence of learning from incidents. Records relating to safeguarding concerns were not accurately maintained and additional information was not made available during the inspection. Care plans were not all readily available on the online system. The provider did not demonstrate that safe recruitment processes for staff had been followed. People were receiving care that was less than the amount they had been assessed for. People told us staff wore appropriate personal protective equipment (PPE) when delivering care in their homes.

Staff training was not up to date. Training which was due to be completed annually had not been refreshed. Not all staff delivering care were included in the staff training matrix. The staff rota was not kept up to date and did not accurately reflect who was providing care and when it was being provided. The care manager explained they were involved with other professionals regarding people’s care however, records had not been maintained to show this collaborative approach. 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.

People felt staff treated them with dignity and respect. However, one relative told us their family member sometimes felt rushed by staff. People were not involved in care planning. People told us they were asked about their experience of the care but were not involved in any formal feedback.

Staff supported people who required end of life care. The care manager informed us two staff had received training in this area. Despite multiple requests, the service did not provide evidence of this training. Most care plans relating to end of life care lacked personalised detail to support people. Care planning was not always personalised.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 10 September 2018 and this is the first inspection.

Why we inspected

This was a planned inspection as the service has not previously been inspected.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, good governance, staffing and fit and proper persons employed.

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

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.