25 November 2022
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 under the Health and Social Care Act 2008.
This was a targeted inspection to check on a concern we had about the management of medicines.
This inspection was completed by three inspectors 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.
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.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was to be sure there would be people and staff available to speak with us.
Inspection activity started on 19 October 2022 and ended on 20 October 2022. We visited the location’s office on 19 October 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 26 people who used the service and relatives over the telephone. We spoke with 15 staff members. This included care staff, office staff, managers, the registered managers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with one external consultant the provider had employed to support the service.
We reviewed 49 people’s medicine and care records. We also looked at records relating to the management of the service, including audits, meeting minutes and call timings.
25 November 2022
About the service
Community Care Worker Limited is a domiciliary care service that provides personal care to people living in their own homes. At the time of our inspection, the service was providing personal care support to 101 people.
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 did not always receive safe care. People were placed at risk because staff did not always stay for the full call duration and risks associated with their care were not always identified and planned for. People’s medicines were not managed safely. People were not always protected against the risk of infection.
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.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Although records showed staff had received training, this had not given them the skills or knowledge needed and this was reflected by what people, relatives and staff told us. Staff did not always feel confident in their role and did not always demonstrate they had learnt from their training. People’s care plans did not include all the information staff needed to be able to support them safely or in the way they wanted.
There was a continued lack of provider oversight of the service to ensure it was being managed safely and in line with current good practice. Quality systems had not identified concerns, errors and contradictory information in care records. An open culture was not embedded at the service and people and their relatives did not always feel well treated and listened to.
Lessons were able to be learnt through incidents which had happened, although further improvement was needed to ensure this was reflected across the whole service.
The provider had worked with other health professionals to deliver people’s care however, the recording of these contacts needed improvement.
Throughout our inspection we received mixed feedback from people, relatives and staff. When people had regular care staff, they considered the service they received to be good. Some people felt some staff are excellent, however some people gave us negative feedback about staff.
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 28 September 2021).
At this inspection, we found the provider remained in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 14 July 2021. Breaches of legal requirements were found. We imposed conditions onto the provider’s registration following that inspection to require them to send us monthly report of actions.
We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Care Worker Limited on our website at www.cqc.org.uk.
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 safeguarding people, safe care and treatment, management of medicines, staff training, consent and the oversight of the quality and safety of care to people.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.