About the service:Crystal Caring is a domiciliary care agency that was providing personal care to 13 people at the time of the inspection.
People's experience of using this service:
We identified six breaches of regulations. These were in relation to safe care and treatment, safeguarding procedures, mental capacity, good governance and the registered managers responsibilities.
At the last inspection on 28 March 2018, we found risk was not managed appropriately. At this inspection we found these concerns continued. People had assessments and plans regarding their care and support needs. However, the care plans lacked important information, were not always kept up to date when changes occurred and had limited guidance for staff in how to deliver individualised care.
Medicines management was not based on current best practice and medicines were not managed safely and in line with national guidance. The systems in place to safeguard people and monitor incidents were ineffective.
People were not always supported to have maximum choice and control in how they wanted their support to be delivered.
The overall governance of the service was not robust and had failed to ensure that people received a service that was safe and in line with best practice. It had failed to ensure that issues were not only dealt with but that subsequent improvements were sustained.
Staff received adequate training People were confident in the ability of staff to provide the support that they needed.
People gave positive feedback about the support they received. There was a small team of dedicated staff committed to providing a caring service to people.
More information is in the detailed findings below.
Rating at last inspection:
Requires improvement, report published 1 May 2018
Why we inspected:
This was a planned inspection based on the rating at the last inspection.
Enforcement:
You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website.
Follow up:
We will continue to monitor the service closely and discuss ongoing concerns with the local authority.
The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
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 have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk