Coldbrock Healthcare

Updated 5 January 2023

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 two Inspectors 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

The service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service prior 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 14 November 2022 and ended on 21 November 2022. We visited the location's office on 14 November and 15 November 2022.

What we did before the inspection

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 reviewed information we had received about the service. We reviewed all other information sent to us from stakeholders such as the local authority and members of the public. We used all of this information to plan our inspection.

During the inspection

We spoke to 7 staff members, including the provider, the registered manager, the care coordinator and 4 care staff.

We reviewed a range of records. This included 3 people's care records and medication records. We looked at 2 staff files in relation to recruitment and supervision. A variety of records relating to the management of the service, including governance systems, policies and procedures were reviewed. We gathered feedback from 2 people and 2 relatives of people who use the service.

After the inspection

We reviewed the evidence sent by the provider electronically. This included the service's staff training data, information related to staff recruitment and other information related to the service.

Updated 5 January 2023

About the service

Coldbrock Healthcare is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of our inspection 16 people were receiving a regulated activity.

At the time of the inspection 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.

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

The registered manager and provider had implemented quality assurance and monitoring systems to improve the outcomes for people. However, these systems were not fully embedded and were not fully effective, including at addressing the shortfalls we identified on inspection. More time was needed to allow whole service improvement and sustained good outcomes for people.

Improvements were made to the recruitment processes. However, more improvements were needed to ensure the provider operated safe staff recruitment practices.

Since our last inspection, the registered manager and provider had ensured risks to people's care were fully assessed, planned, or documented.

People and their relatives were complimentary about the support they received. Comments included: “I find the carers quite good we can have a laugh and a joke with them. They are very polite and friendly.” and “Mum’s happy with the care and the carers she has a good laugh with them.”

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 25 August 2022).

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 improvements had been made, however the provider was still in breach of the regulations.

Why we inspected

We carried out an announced focused inspection of this service on 04 July 2022 and 08 July 2022. 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 safe care and treatment and good governance.

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 17, and requirement notices in relation to Regulation 12 and Regulation 19 Care Quality Commission (Registration) Regulations 2009, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also received information of concern in relation to people's personal care since our last inspection.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For the key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Coldbrock Healthcare 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 continued breaches in relation to staff recruitment and good governance, 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.