Background to this inspection
Updated
10 September 2021
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 Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in in their own homes.
The service had a manager registered with the Care Quality Commission. 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.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the manager would be in the office to support the inspection.
Inspection activity started on 15 April 2021 and ended on 26 April 2021. We visited the office location on 16 April 2021.
What we did before the inspection
We reviewed information about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We spoke with the service manager and two care workers. We spoke with two people and two relatives. We reviewed a range of records. This included two people's care and medicines records, and two staff files in relation to recruitment and staff supervision records. A variety of records relating to the management of the service, including quality assurance records were reviewed. We reviewed the service’s policy on supporting people with medicines.
Updated
10 September 2021
About the service
This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection they were providing services to six people, and two of these were receiving support with 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
People were being supported to take their medicines by care staff, but there were no medicines risk assessments or care plans in place. Proper records of the support people were being given with their medicines were not being kept. The service's medicines policy had not been updated to bring it in line with guidance or refer to current regulations.
Staff were not being recruited safely. Legally required pre-employment checks had not been carried out to ensure that staff were of good character and suitable to provide care and support to people.
The registered manager was unable to participate in the inspection, and had delegated the running of the service to the manager. Although some improvements had been made since the last inspection, the service did not have robust governance or quality assurance systems in place.
People and their relatives spoke highly of the care they were receiving. One relative said, “The carers who come in are brilliant… the care is on point.” We were told that people had regular, experienced staff who understood their needs.
Care staff usually attended visits on time and communicated well on occasions when they were running late. A relative said, “They have never left us in a bind.”
Risks to people’s safety had been assessed and documented in an appropriate level of detail.
People told us they felt safe and they were cared for by staff who whose training was up to date, and understood how to protect them from abuse and report any concerns.
People and their relatives told us that if things went wrong they would be comfortable in contacting the office and felt confident they would be listened to.
Staff told us they were supported by the service manager and had regular supervision and appraisal.
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 requires improvement (published 25 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for four consecutive inspections.
Following our last inspection, we served warning notices on the provider. We required them to be compliant with Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 26 May 2020.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Enforcement
We have identified breaches of the regulations relating to the safe management of people’s medicines, safe recruitment and the good governance of the service at this inspection.
We have issued a Warning Notice for Regulation 17 (Good governance).
Follow up
The overall rating for this service is ‘Requires improvement’ and the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.