Background to this inspection
Updated
21 September 2023
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 Health and Social Care Act 2008.
Inspection team
This inspection was completed by 2 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.
Registered Manager
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 not a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
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 reviewed information we had received about the service since registration. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We also contacted the Home Office to gain information about the issues regarding the staff.
We used all this information to plan our inspection.
During and after the inspection
We spoke with 4 people who used the service and 4 relatives about their experience of the care provided. We spoke with or received emailed responses to a questionnaire from 9 care staff, a care supervisor, the manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included all or parts of 6 people’s care records, medication administration records and the daily notes recorded by care staff. We looked at 3 staff files in relation to recruitment and staff supervision and a variety of records relating to the management of the service, including policies and procedures and training records.
Updated
21 September 2023
About the service
Inner City Care – Lancaster House is a domiciliary care service providing personal care to 17 people at the time of the inspection. 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’s care records and risk assessments were not comprehensive, did not always reflect people’s care needs and were not always person-centred.
Quality assurance processes were ineffective and did not highlight the concerns we have raised throughout this report. A manager had been in place for two months at the time of the inspection. There had been 3 managers in 12 months which has contributed to the inconsistent care planning, risk assessment and quality assurance of the service as a whole.
Medicine records were inconsistently completed. People felt safe when staff cared for them in their homes; however, safeguarding and accident and incident reporting and investigation processes were inconsistent. Guidance and assessments provided by other health and social care professionals had not always been used to form meaningful care plans, placing people at risk of inconsistent or inappropriate care.
Most people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not always support this practice. We found the paperwork used to record and assess people’s ability to make decisions for themselves did not always follow the requirements of the Mental Capacity Act 2005 (MCA). We have made a recommendation about this in the effective part of this report.
Staff had completed mandatory training; however, other training, which the provider told us should have been completed by staff, had not yet been completed by all. The provider did not have the processes in place to monitor and address this with staff.
People’s communication needs were not always taken into account to reduce the risk of discrimination. People’s protected characteristics were not thoroughly considered when care was planned. People’s hobbies and interests, likes and dislikes were not always recorded in their care records.
People felt their medicines were well-managed; however, improvements were needed to ensure records relating to the management and administration of medicines were consistently completed.
People found staff to be kind and caring. Staff followed infection prevention and control practices to keep people safe.
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 9 January 2020). The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.
Why we inspected
The inspection was prompted in part due to concerns received about staff recruitment and suitability to work. A decision was made for us to inspect and examine those risks.
We found evidence that the provider needed to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
We have identified 2 breaches in relation to safety and governance at this inspection. We have made one recommendation in relation to the Mental Capacity Act 2005.
Please see the action we have told the provider to take at the end of this report.
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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.