Care at Home Group Cheshire East and West

We assessed 8 quality statements under the safe key question, identifying both good practices and areas of concern. The overall rating for this key question is requires improvement. We found 1 breach of the legal regulation in relation to safe management of medicines.

Systems were in place to report and record events, including the analysis of wider themes and issues, which were shared with staff and leaders. The provider had a safeguarding policy, and incidents were reported to the local authority. However, we found some incidents which should have been reported to the CQC had not been submitted.

People’s care was assessed before care calls began, risk assessments and care plans were developed for staff to follow. Feedback on how care plans were updated was mixed, some staff described instances when they had updated the office staff after working with people to address changes in their care.

Improvements were needed in the safe management of medicines, the manager responded promptly to concerns we identified in this area. Feedback from people, relatives, and partners highlighted issues with rostering and inconsistency of calls which had impacted on people’s safety. However, we also received some positive feedback about recent improvements in this area.

We assessed 6 quality statements under the effective key question, identifying both areas of good practice and concern. The overall rating for this key question is good.

Feedback from people and staff regarding the scheduling of calls and staff consistency was varied. While some noted recent improvements in working within smaller areas, many expressed concerns about rostering inconsistencies and the challenges of managing travel across large geographical areas to attend calls. People and relatives described staff as kind and respectful of their choices. Care needs were assessed before care commenced; however, many people reported that their care plans were not reviewed regularly, nor were they asked for feedback. Staff also shared experiences of being unaware of changes to care plans until informed by the person during the call.

We assessed 5 quality statements under the caring key question, identifying both areas of good practice and areas requiring improvement. The overall rating for this key question is good.

People generally reported that staff treated them with kindness and compassion during care calls. Staff acknowledged challenges related to rostering and attending calls but also highlighted recent improvements and changes in these areas.

Care plans included information about individuals’ personal histories and preferences, enabling staff to provide personalized care and support people to maintain their independence. Many individuals expressed appreciation for having regular and consistent staff attending their calls, emphasizing the positive impact of these relationships.

We assessed 7 quality statements under the responsive key question, identifying both areas of good practice and areas requiring improvement. The overall rating for this key question is good. People received person-centred care that reflected their personal preferences, identity, and wishes, including those related to end-of-life care. Care plans were thoughtfully written to capture these details. Staff had also engaged in recent training to enhance their skills and understanding in this area.

However, many individuals reported not having seen their care plan or participated in reviews of their care. Additionally, some found it challenging to communicate with senior staff or leaders regarding their care. Improvements were needed in communication and care plan reviews. These issues had already been identified by the service, and work was underway to address them.

We assessed 7 quality statements under the well-led key question, identifying both areas of good practice and areas of concern. The overall rating for this key question is requires improvement. We found 1 breaches of the legal regulation non-reporting of safeguarding events to CQC.

While audits and checks were in place, they did not identify all failings found during our assessment, including issues with medicines management and the reporting of events to the CQC. The management team acknowledged these shortcomings and had taken actions to address some of the concerns. Further work is required to embed improvements into practice, including areas highlighted during this assessment.

Staff generally described the manager and senior office staff as approachable. Many noted improvements in recent months, although some expressed that further progress was needed in communication about people’s care calls and staff support. The manager is continuing to address these issues to drive ongoing improvement.