Main Office

Updated 16 March 2024

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 1 inspector, 1 regulatory co-ordinator 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service a short period 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 date 08 January 2024 and ended on 15 January 2024. We visited the location’s office on 08, 09 and 10 January 2024.

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 who work with the service. 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 2 people who use the service to understand people’s experiences of the care provided. We spoke with 1 relative to understand their experiences. We spoke with 6 members of staff including the registered manager care staff.

Updated 16 March 2024

About the service

Main Office is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection there were 5 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. At the time of our inspection there were 3 people receiving a regulated activity.

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

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:

Some people did not have all relevant health specific risk assessments in place, but staff had received training relevant to their roles including Learning Disabilities and Autism.

Some people did not appear to always receive medicines they were prescribed. Audit systems were not effectively used to identify gaps in recording of medicines in a timely manner.

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 but was not embedded.

Right Culture:

Oversight of the service required improvement. We identified shortfalls at inspection that had not been independently identified by systems and processes already in place. These included audits not effectively being used to identify risk. This meant opportunities to make improvements were lost. People using the service and staff felt the culture was open, and the registered manager was easily accessible. Concerns raised were listened to and people and staff had faith the registered manager would act upon any issues to make positive changes for people where needed. People were happy with the care they received from a consistent team of care workers.

Right Care:

Systems were in place to identify safeguarding concerns, although there were no recorded incidents to review to demonstrate practice was embedded. Staff were able to identify adult safeguarding concerns and the registered manager was aware of their responsibility to investigate and report concerns to relevant partner agencies.

People were supported by staff who were highly passionate about delivering good care and going above and beyond for people. Staff understood consent and processes to support the assessment of people’s capacity was in place. It was difficult to establish if practice was embedded as people’s capacity in relation to decision specific choices had not been assessed.

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 02 November 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 some regulations.

Why we inspected

We carried out an announced inspection of this service on 08 January 2024. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve how risks were identified and monitored; how medicines were administered; how staff were recruited safely and how governance of the service would be improved.

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, 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 Main Office on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to people’s care needs and associated risks not always being assessed; safe administration of medicines and how the service was governed at this inspection.

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.

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.