Immaculate Care Limited

Immaculate Care Limited is a domiciliary care agency which provides care and support for people in their home. At the time of the inspection the service were providing support for 13 people from which 12 people were receiving the regulated activity of personal care. 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.

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

People’s medicines were not always managed in way to ensure they were administered as prescribed. Risks were not always identified. The provider had not always developed risk management plans to provide staff with guidance on how to mitigate risks. We made a recommendation in relation to the recruitment processes as they were not robust. This meant they could not demonstrate new staff had the required skills and knowledge for the role.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice. Staff had not completed training to meet people’s specific care needs.

Care plans did not always provide information on the person’s current support needs. People’s communication support needs were not always identified. The provider’s quality assurance processes were not robust enough to identify where improvements could be made to the way the service was provided.

The provider had made improvements to the staffing of the service with adequate travel time provided between visits and enough staff to provide the care. There had been no incidents and accidents, safeguarding concerns or complaints raised since the previous inspection.

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 15 December 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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider reviewed the nutritional and hydration needs of people to ensure their needs were properly supported. At this inspection we found the provider had not reviewed this information to ensure people’s needs could be met.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the key questions of Safe, Effective, Responsive and Well Led sections of this full report.

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 inspection reports and timeline’ link for Immaculate Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, need for consent, safe care and treatment 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.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Immaculate Care Limited provides personal care and support to older people and people with disabilities living in their own homes. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. At the time of our inspection all 23 people received personal care.

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 were people using the service who had a learning disability.

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

People's medicines were not being managed in a safe way which put people at risk. Not all staff were assessed as safe to administer medicines to people. Accidents and incidents were not always reported, and actions were not always taken to reduce reoccurrence of them. Risks associated with people’s care was not being assessed appropriately.

The provider had not ensured that there was sufficient organisation of the staff rotas and we found that staff were at times late for calls and did not always stay for the duration of the call. The recruitment of staff was not robust which put people at risk. Staff were not sufficiently trained or supervised to ensure that they were competent to carry out their role.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Prior to people receiving care there was a lack of assessments of their needs. People's care was not provided in a consistent way. Care plans lacked detailed and guidance for staff. Care plans lacked information about people's backgrounds, interests and things that were important to them. Where people were being cared for at the end of their lives there was no care planning in place around this.

There were no systems in place to assess the quality of the care being provided. The provider and registered manager were not always being open and transparent in relation to the care that was being delivered.

Staff understood what to do to prevent infections however relatives fed back that staff were not always wearing personal protective equipment. We have made a recommendation around this.

There were people and relatives that told us that they felt safe with staff. However, staff were not aware of the procedures around reporting a safeguarding concern. There was also information missing in people’s care plans around their nutritional and hydration needs. We have made recommendations around both of these areas.

People and relatives felt some staff developed good relationships with their loved ones. People told us that staff were respectful towards them. Staff fed back they felt supported by the leadership.

Right Support: People’s care was not always being assessed to ensure they were receiving the most appropriate care.

Right Care: Care was not always person-centred around the wishes of the people they were supporting.

Right Culture: The provider and registered manager lacked an understanding of the needs of people with a learning disability.

Rating at last inspection

This service was registered with us on 19 November 2020 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service and as part of our inspection scheduling for newly registered services.

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 safe care and treatment, the lack of robust recruitment and staff levels, training and supervisions. We have also identified breaches in relation to the lack of care planning, lack of understanding of capacity assessments and lack of effective audits.

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. 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.

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.