Grace 247 Care Wiltshire

Updated 4 March 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 undertaken by two inspectors, an assistant inspector 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, but they were absent from work. A new manager had been appointed and they were in the process of registering with the Care Quality Commission to become the registered manager.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 28 November 2022 and ended on 23 December 2022. We visited the location’s office on 28 November 2022 and 19 December 2022.

What we did before the inspection

We reviewed information we had received about the service since the last 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 used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with 5 people who used the service, 6 relatives, 11 staff including the new manager and provider. We gained feedback from 1 health and social care professional. We looked at care planning documentation and associated risk assessments, medicine administration records and information related to the management of the service.

Updated 4 March 2023

About the service

Grace 247 Care Wiltshire 247 is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection there were 48 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.

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

Risks people faced had not always been identified, assessed or mitigated. This included the management of healthy skin and choking risks. Some staff were working excessive amounts of hours, but the risk of them becoming tired and making mistakes had not been assessed. People told us there were enough staff to support existing care packages, but a robust recruitment procedure was not in place. People’s medicines were not safely managed. There had been an error and the records did not always show the medicines were administered as prescribed. People told us they felt safe with staff supporting them, and staff knew how to identify and report abuse. Systems were in place to ensure good infection control practice was followed.

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. People were supported to have enough to eat and drink, and any ill health was reported to the office. Contact was then made with the person’s family or healthcare professional so further action could be taken. Staff received a range of training deemed mandatory by the provider and received informal support as required. A formal system of staff supervision was in the process of being reinstated.

Feedback about the staff was variable. Some people told us staff were caring, lovely, helpful and sensitive. Others and their relatives were less complimentary. Complaints had been made to the manager about some of the staff and their attitude. The manager had plans in place to address this and said some of the staff were not working as they expected them to. People told us their privacy, dignity and independence were promoted.

People were generally supported by the same staff, which ensured consistency. People said staff usually arrived on time, although not always at their time of preference. Some people told us they were happy with their support, with one comment being “Generally, care is of a good standard and communication is good”. Care planning was often task orientated and did not reflect people’s individual needs. There was limited guidance for staff to help them manage people’s health conditions. People knew how to raise a concern or make a formal complaint, although complaints were not always responded to. The provider told us this fell short of their expectations and would be addressed.

The provider had failed to submit an application to the Care Quality Commission regarding the change of the agency’s location. This was despite being reminded of the need to do so. This shortfall was a breach of the condition of the provider’s registration.

Audits were taking place but not always identifying shortfalls in the service. This included shortfalls found during this inspection including those related to risk management, care planning and the management of people’s medicines. Systems were in place to encourage feedback and an open culture. The manager was planning to meet with people and their relatives to introduce themselves and talk about their support. They had developed a new staff structure to enable more effective support and supervision.

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 us on 07 January 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staff working excessively long hours and lack of staff training. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, fit and proper persons employed, need for consent, person centred care 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.