About the service: Eternal Care UK Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The service provides personal care to adults some of whom have dementia. At the time of the inspection there were 59 people receiving personal care from the service.For more details, please see the full report which is on the CQC website at www.cqc.org.uk
People’s experience of using this service:
At our comprehensive inspection of 28 June 2016, we found the provider had not acted to make sure medicines were managed safely. We took enforcement action. At our inspection on 12 and 13 December 2016, we found that the provider had addressed the breaches of regulation, however at the 2 and 3 August 2018 inspection we found that these improvements had not been sustained and we took enforcement action. At this inspection, we found the provider had not made sufficient improvements for managing medicines since the last inspection. Medicines were still not always being managed safely.
At the inspection on 2 and 3 August 2018, we found staff did not always attend people's care calls as required. The provider sent us an action plan and told us that they would complete all required actions by 5 October 2018. However, when we returned to the service on 28 and 29 March and 2 April 2019, we found this was not the case.
At the inspection on 2 and 3 August 2018, we found there was no risk assessments for people using bedrails and risk assessment reviews were not completed for people who had come out of hospital. At this inspection we found there was no risk assessments and management plans for people with challenging or complex behaviour at times.
At the inspection on 2 and 3 August 2018 we found when people lacked the capacity to make important decisions for themselves the provider had failed to maintain a record of decisions made in their best interests, in line with the Mental Capacity Act 2005. At this inspection we found the provider had not made improvements, when people lacked capacity to make important decisions for themselves to ensure that their rights were protected.
At the inspection on 2 and 3 August 2018 we found two people’s care plans did not reflect people’s current needs. The provider sent us an action plan and told us that they would complete all required actions by 5 October 2018. However, when we returned to the service on 28 and 29 March and 2 April 2019, we found improvements had not been made.
At our last comprehensive inspection on 28 June 2016 we found that effective systems were not in place to monitor and improve the quality and safety of the service provided to people. At the inspection on 12 and 13 December 2016, we found that the provider had addressed the breaches of and were compliant with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.However, at the inspection on 2 and 3 August 2018 we found the provider had not always ensured that they monitored people’s calls to check if they were attended as per their scheduled time through an electronic or a manual call monitoring system.
At this inspection we found call monitoring was not effective. The electronic call monitoring system did not provide accurate records of staff visits.
A people’s satisfaction survey carried out in July 2018 was not analysed and an action plan was not developed to drive any improvements. The provider had not ensured that people’s information and their records were maintained safely.
People’s needs were assessed to ensure these could be met by the service.
The provider trained staff to support people and meet their needs. Staff told us they felt supported and could approach the new manager at any time for support.
Staff supported people to eat and drink enough to meet their needs.
People were protected from the risk of infection. The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.
The provider worked with other external professionals to ensure people received effective care. People were supported to maintain good health.
The provider completed home environment assessment and made referral to external professionals for their support.
Staff supported people and showed an understanding of equality and diversity. People and their relatives were involved in the assessment, planning and review of their care. People were treated with dignity, and their privacy was respected. The provider had a policy and procedure to provide end-of-life support to people.
People told us they knew how to complain and would do so if necessary.
The new manager and staff worked as a good team. The service had an on-call system to make sure staff had support outside office working hours and staff confirmed this was available to them.
The new manager encouraged and empowered staff to be involved in service improvements through periodic meetings. People and their relatives were involved in the planning and review of their care and support.
The new manager completed checks and audits on accidents and incidents, complaints, staff training, and safeguarding. The senior staff carried out spot checks of staff to ensure care was provided as planned.
The new manager and the provider remained committed to working in partnership with other agencies and services to promote the service and to achieve positive outcomes for people.
Rating at last inspection: Inadequate (report published on 17 October 2018).
Why we inspected: This was a planned inspection based on the last inspection rating.
Enforcement: Action we told provider to take (refer to end of full report)
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.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that
providers found to have been providing inadequate care should have made significant improvements within this timeframe.
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.
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.
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.
Follow up: We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.