Rings Homecare Greater Manchester Also known as RHS GREATER MANCHESTER

Greater Manchester, known by people using the service as Rings Homecare, is a domiciliary care service based in Bolton, Greater Manchester. The service is registered to provide care and support to children, younger and older adults living in their own homes.

Not everyone who used the service received personal care. The Care Quality Commission (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 inspection, 42 people received personal care and were included in the inspection.

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

We found improvements were required with medicines management, record keeping and the audit and governance process. Record keeping and documentation relating to people’s medicines was not always completed fully, accurately or in line with the provider’s policy. The provider’s audit process had not identified the issues we noted on inspection.

People and relatives we spoke with, told us the service provided safe care. Staff had completed training in safeguarding and knew how to report concerns. Care staff completed their visits on time and remained for the full length of the call. New staff had been recruited safely, with all necessary safety checks completed. Risks to people had been assessed, with information in care plans on how these would be minimised as much as possible.

People and relatives told us they were happy with the service, and most would recommend the company to others. People’s views had been sought through telephone reviews with either themselves or their next of kin. Everyone we spoke with told us communication with and from the service was good. Staff’s views were also sought through regular meetings and surveys.

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 4 October 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out a focused inspection of this service in August 2022. Breaches of legal requirement were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection (published January 2020) to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence 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 Greater Manchester on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and the audit and governance process 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.

Greater Manchester, known by people using the service as Rings Homecare, is a domiciliary care service based in Bolton, Greater Manchester. The service is registered to provide care and support to children, younger and older adults living in their own homes, although the service was currently not supporting any children.

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 inspection, 55 people used the service, however, only 40 of these received personal care and were included in the inspection.

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

We found improvements were required with person centred care, linked to the timing of people’s care visits, medicines management and the audit and governance process.

We received mixed feedback about the timeliness of care visits, and documentation showed visits were sometimes later than scheduled. Medicines were not being managed safely, record keeping was inconsistent and some people’s medicines had not been given timely. The audit process was new and not embedded into practice. Monitoring systems had not identified all the issues we found on inspection and due to the lack of an improvement plan it was not clear what actions were being taken to address shortfalls.

People told us they felt safe using the service. Staff had been recruited safely, with all necessary pre-employment checks completed. Staff had completed training in safeguarding and knew how to report concerns. Risks to people had been considered, although more detail was needed on the assessments, to ensure staff had all the information they needed to keep people safe.

Overall people said they were happy with the service and knew who to speak to, to raise any issues. Communication was reported to be an issue at times, both in terms of getting through to office staff and language barriers between people and some care staff. People’s views had been sought through telephone surveys and discussions, although not everyone we spoke with could recall this taking place.

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 21 September 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out a focused inspection of this service in August 2021, due to receiving concerns about call timings, late or missed visits, medication, recruitment checks and the use of restraint. Breaches of legal requirement were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection (published January 2020) to calculate the overall rating. The overall rating for the service has remained 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 Greater Manchester 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 person centred care, medicines management and the audit and governance process at this inspection.

You can see what action we have asked the provider to take at the end of this full 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 also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

People who used the service and their families raised concerns with us about the timeliness of care visits which on occasions, had impacted on the care people received. People did not always receive their medication safely due to sufficient time not always being left between visits and people’s medication administration records (MAR) were not always fully completed.

People raised concerns with us about staff not always wearing the correct personal protective equipment (PPE) when arriving to provide their care. Although disclosure and barring service (DBS) checks were undertaken, they did not always cover staff to work with children. Some care plans and risk assessments lacked specific details about people’s care. There were gaps in call monitoring logs, where entries had not been made to show what time staff arrived at and left a care visit. We have made a recommendation that staff complete training regarding the use of restraint.

Improvements to governance systems were required to ensure they were effective in identifying some of the concerns found during the inspection. Since the last inspection, the service had changed office locations, although, had not registered this location with CQC before moving. The service had two managers registered with CQC, although, steps had not been taken for one of them to de-register. We had not been notified about a safeguarding allegation of financial abuse that had occurred. We asked the registered manager for this to be submitted to us urgently.

There were systems in place for people who used the service and staff to provide feedback about their care through surveys and meetings. The staff spoken with during the inspection told us they felt the service was well-led.

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 January 2020). At this inspection, this rating had not been sustained and the provider was found to be in breach of regulations.

Why we inspected

The inspection was prompted in part due information of concern we received from several whistle-blowers prior to our inspection. This included concerns raised regarding call timings, late or missed visits, medication, recruitment checks and the use of restraint. A decision was made for us to examine those risks. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

Prior to this inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions (Effective, Caring and Responsive). 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 has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greater Manchester on our website at www.cqc.org.uk. You can see what action we have asked the service to take at the end of this report.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Greater Manchester is a domiciliary care service based in Bolton and provides care and support to people living in their own homes and is operated by Rings Homecare Service Ltd. At the time of the inspection there were 15 people using the service.

People’s experience of using this service:

People told us they felt safe using the service and staff displayed good knowledge about how to protect people from the risk of harm. People told us they received their medicines as prescribed. Staff were recruited safely, with appropriate checks carried out when their employment commenced.

There were enough staff to care for people safely, with staff and people using the service telling us current staffing arrangements were sufficient. Staff said their rotas were well managed, with sufficient travel time between each care visit.

People received the support they needed to eat and drink. Staff told us they were happy with the level of training, support and supervision available to develop them in their roles.

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 said they felt treated with dignity and respect and staff promoted their independence as required. Complaints were handled appropriately, and a number of compliments had been received by the service. Spot checks and competency assessments of staff carrying out their work were completed.

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 CQC in December 2018 and this was the first inspection we had undertaken.

Why we inspected:

This was a routine comprehensive inspection and in line with our timescales for newly registered services.

Follow up:

We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for Good rated services, however if any information of concern is received, we may inspect sooner.