Rapid Improvement Care Agency

Rapid Improvement Care Agency is a domiciliary care agency providing personal care to older people in their own homes. At the time of the inspection, there were 80 people using the service who were receiving help with personal care. The Care Quality Commission (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 and their relatives were positive about the care they received from the provider and told us they felt safe.

At the last inspection, we found breaches in relation to fit and proper persons employed and good governance. At this inspection, we found the provider had acted upon the breaches found and also the recommendations we made in relation to safeguarding people from abuse, complaints management and end of life care planning.

Risks to people were assessed and care plans included ways in which staff could support people to remain as safe as possible. People were given their medicines on time from staff who were trained to do so.

Staff recruitment checks were robust and helped to ensure only those who were safe to support people were employed. There were enough staff employed to support people and the provider checked care worker visit times to assure themselves that people received their care visits as scheduled.

Staff followed up to date infection control guidelines when supporting people.

Care plans were person centred and individual to people’s needs. Where people had communication support needs, these were recorded and included ways in which staff could communicate with them in a way that they understood. End of life care plans captured people’s wishes and how they wanted to be cared for towards the end of their life.

The service was managed well by an experienced registered manager. The provider had acted on our feedback from the previous inspection to make positive changes to the service. Governance systems were effective in assessing the quality of care provided.

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 04 August 2022) and there were breaches of regulation in relation to Fit and proper persons employed and good governance.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made in relation to the breaches and the provider was no longer in breach of these regulations.

Why we inspected

This inspection was carried out to look at improvements against the breaches found at the previous inspection. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We did not inspect the key questions of effective and caring. 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 to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rapid Improvement Care Agency on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rapid Improvement Care Agency is a domiciliary care agency providing personal care to people in their own homes.

At the time of the inspection, there were 75 people using the service. The Care Quality Commission (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

Although we received positive feedback from people, relatives and staff about how the service was managed, we found the provider’s recruitment checks were not robust enough and we could not be assured staff were recruited safely. We also found the provider’s quality assurance checks were not robust enough to identify this issue and statutory notifications that needed to be submitted to the Care Quality Commission were not sent.

Although staff were given training that met the needs of people using the service, we found that staff supervisions were not being completed regularly. The registered manager told us the frequency of these had been impacted due to Covid-19. We have made a recommendation to the provider about restarting more frequent one-to-one supervisions.

We have made a recommendation to the provider in relation to updating its safeguarding and complaints policies to make them more comprehensive.

We have also made a recommendation to the provider about developing more comprehensive care plans in relation to end of life care.

People and their relatives were very happy with the service and care they received. They told us they felt safe and were supported by a regular team of care workers who attended their calls on time and stayed for the full duration of their visit. Infection control and medicines practices were safe. The provider assessed risks to people which included steps to manage and minimise the risk. This helped to keep people safe.

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.

The provider carried out assessments, often at short notice before they started to provide care to people. People were supported by the provider to meet the health and dietary needs.

The service was caring. People and their relatives praised the care workers for their empathy and caring attitude. They told us that care was delivered in a way that was discreet and dignified, and their privacy was respected. People and their relatives were involved in planning their care and told us their care plans were reviewed regularly.

Care plans were individual to people, reflecting their current needs. The provider considered the views of people and their relatives when developing care plans and they were reviewed regularly. People told us that care workers supported them according to their preferences. People and their relatives told us they knew how to complain if they were not happy and felt they could approach the provider if they were not satisfied with their care.

The provider engaged with people, relatives and staff, listening to their views and considered their feedback. People told us they service was well managed. They felt the registered manager was approachable. There were systems in place to monitor the quality of service.

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 good (published 14 December 2018).

Why we inspected

This was a planned inspection based on when the service registered with us and due to concerns received about safeguarding and complaints management procedures. A decision was made for us to inspect and examine those risks.

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 fit and proper persons employed and good governance at this inspection. Please see the action we have told the provider to take at the end of this full 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Some people supported by Rapid Improvement Care Agency did not receive a regulated activity from the service. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

This inspection was carried out on 7 and 8 November 2018 and was announced.

At the last inspection, carried out on 31 October 2017, the service was rated Good, with Requires Improvement in safe. We found a breach of Regulations relating to people’s safe care and treatment. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We have also change the rating for Safe from Requires Improvement to Good, because of the good practice we saw. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks to people's health and safety were sufficiently identified and appropriate risk management plans were in place to mitigate the potential risks to people. Staff were aware of the service’s procedures to provided immediate support to people if they noticed people being at risk to abuse or when incidents and accidents took place. Staff provided references and criminal records checks were carried out before they were employed by the service. People had support to manage their medicines safely. Relatives told us that staff had not always arrived for their shifts on time but to address this the service was in the process to start using a new electronic system to monitor staff’s punctuality and length of their visits.

Systems were in place to review staff’s performance and competence on the job. Staff supported people to identify any health-related issues and sought support to ensure their good health. People had assistance to meet their nutritional needs. Staff followed the Mental Capacity Act 2005 (MCA) principles to support people in the decision-making process. Although staff were trained in the areas the provider considered mandatory, some staff lacked knowledge and skills to support people effectively, but the provider had identified this and addressed as necessary.

Relatives described staff as kind and friendly. People consented before staff started supporting them with personal care. Staff respected people’s preferences and were aware of what was important to people, including their cultural and religious needs. Staff had training and were aware of the confidentiality principles they had to follow. However, people's relatives reported some concerns in relation to staff’s attitude and how they supported people’s privacy but the service took action to address this.

People’s care needs were assessed and staff were provided with sufficient levels of information relating to people’s health conditions, communication difficulties and end of life care needs. Regular review meetings were facilitated to find out if people had the right support. Systems were in place to gather people and their relatives' feedback about the service.

People’s relatives felt that the service was well led which ensured safe care for people. The culture of the service promoted team working and staff’s involvement in making decisions about the care delivery. Systems were in place to support and motivate staff in their job. Regular audits were carried out to check if people’s care records reflected their current needs.

Further information is in the detailed findings below.

Rapid Improvement is a domiciliary care agency that provides personal care for seven children and 42 adults living in their own homes who may have dementia, end of life care needs, learning and physical disabilities.

At the last inspection on 7 September 2015 the service was rated GOOD.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risk management plans had not addressed the support people required to minimise risks to their wellbeing. Information was missing on the assistance people required to meet their individual needs.

Systems were in place where there had been safeguarding concerns which ensured that any risks to people were monitored and actions taken to protect people as necessary. People told us that staff were on time and stayed for the full duration of their shifts as necessary. Staff had all the necessary pre-employment checks which helped to ensure their suitability for the role. Staff worked in conjunction with relatives and health professionals to ensure that people were assisted to take their medicines as prescribed. Some medicines administration sheets where not signed for by staff but this was already addressed by the management team.

Staff accessed appropriate training that gave them the knowledge and skills to support people effectively. The staff team had support to ensure good care for people. Staff were confident that any concerns raised would be investigated by the registered manager and acted upon. Staff understood and complied with the requirements of the Mental Capacity Act (MCA) 2005. Staff knew the importance of supporting people to make their own decisions where possible. Guidance and support from healthcare professionals was implemented into the care delivery to people. People had access to sufficient amounts of food and drink to meet their dietary requirements and complex nutritional needs.

Staff were patient and made people feel at ease when assisting them with personal care. People had their individual needs respected and attended to with care. Staff encouraged people to engage and undertake activities for themselves which increased their independence.

Care records lacked information about people’s individual interests and preferences. We have made a recommendation about this.

The registered manager was aware of people’s individual needs and involved other agencies in the assessment and delivery of care to people. Complaints were recorded, monitor and acted upon to ensure that issues raised were dealt with appropriately. People and their relatives were confident that their views were listened and adhered to in a professional manner.

There were good communication systems in place that enabled staff to share information efficiently. Staff had a say in care delivery which motivated their involvement in providing good support for people. The management team worked together and shared responsibilities to monitor the service’s performance.

We found a breach in relation to safe care and treatment. You can see what action we have taken at the back of the full version of the report.