Background to this inspection
Updated
10 April 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 consisted of two inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
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
The inspection was announced. We gave the service 1 day notice before each visit to the office as part of the inspection process. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We liaised with the Local authority and the information we have received regarding the service since the last inspection.
During the inspection
We spoke with 17 people or their family members using the service. We spoke with 8 care staff, the registered manager, deputy manager and the nominated individual.
We reviewed care records for 15 people and multiple medicines records. We also reviewed service records, including staff records, training records, quality, and safety monitoring records, as well as policies and procedures.
Updated
10 April 2024
About the service
Evolving Care limited is a domiciliary care service providing care and support to people living in their own homes. At the time of our inspection the service was providing personal care to 166 people.
People’s experience of the service and what we found
We received feedback from people and families about requested changes to times that could not be fulfilled and reports of staff being late, frequent breakdown of staff vehicles and staff changes without informing the person or the family member.
People told us that they felt safe whilst receiving care and many were complimentary about the standard of care.
Risks to people's health, safety and well-being were not effectively managed after incidents.
The management of people's medicines remained unsafe. Medicine records and risk assessments were not effectively managed or updated. We were not assured that annual medication competencies for staff and senior staff were effectively managed.
Safeguarding notifications were not always made to CQC. This was corroborated with the local authority and our notifications system.
Staff were not always recruited safely. We were not assured that the quality of the induction training as well as the training courses content was effective. Training compliance information was observed and staff feedback on the process and experience differed.
Rotas were not suitably maintained. We found on two consecutive visits that the rota's were not complete for the following week, and this was corroborated by staff.
We received feedback from people and families about requested changes to times that could not be fulfilled and reports of staff being late, frequent breakdown of staff vehicles and staff changes without informing the person or the family member.
People told us that they felt safe whilst receiving care and many were complimentary about the standard of care.
We saw there had been improvements in the quality systems and auditing processes from the last inspection, the service had made improvements to monitor the care system that staff use daily from the office and on an on-call/out of hours basis, as well as auditing the system and analysing service data periodically with an action plan to complete.
Right Support, Right Care and Right Culture:
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was people using the service who have a learning disability and or who are autistic.
Right Support
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. Risk assessments and care plans had been developed to meet people's needs.
People were supported to access healthcare and other specialist services. Staff worked closely with other professionals and organisations to ensure positive outcomes were achieved for people.
Right Care
People received a caring service and a consistent team of staff to ensure consistency and continuity. Staff protected and respected people's privacy and dignity, understanding and responding to their individual needs. People could communicate with staff because staff supported them consistently
People had opportunities to participate in activities they were interested in as well as regular contact with family members and friends.
Right Culture
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 care and support plan 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 23 August 2021.
We requested an action plan from the last inspection from the provider to understand what they did to improve the standards of quality and safety and the breaches identified.
Why we inspected
The inspection was prompted in part due to concerns received about staffing concerns staff working patterns and workload . A decision was made for us to inspect and examine those risks.
We undertook a focused inspection to review the key questions of Safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Evolving Care Limited on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to reporting notifications, safe care and treatment, staffing and good governance.
Please see the action we have told the provider to take at the end of this report.
Follow Up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
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.