12 December 2022
During a routine inspection
About the service
Sentricare is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection the provider initially told us there were 12 people using the service. However, due to information being shared with us by a whistle-blower, we later established we had been provided with incorrect information by the provider. Based on additional information shared with us by the provider, they provided a list of 88 people using the service. Again, during the inspection, we found this number was incorrect and had increased to at least 92 people using the service. We are still seeking clarification from the provider to establish the accurate number of people using the service. The service was providing support to children, older and younger adults, people living with; dementia; learning disabilities; autism; mental health conditions; physical disabilities and sensory impairments.
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
The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured of the choices and involvement of people who used the service in their care and support. Initially the provider told us they did not support any people who lacked capacity, had a learning disability or autism or expressed emotional distress. However, we identified that there were several people being supported by the provider who had multiple needs including those with a learning disability.
Right Support
People were not always supported to have maximum choice and control of their lives as they told us they were not routinely involved in care reviews and when they had raised concerns these had not been addressed. Staff did not always support them in the least restrictive way possible and in their best interests.
We found guidance within peoples care plans for staff members to follow when supporting autistic people or people with a learning disability who may express distress or frustration, was inadequate. Care plans and risk assessments did not provide staff with information on how to respond to such expressions of distress, how to de-escalate or how to provide positive re-enforcement.
Staff training and record keeping needed to be improved in relation of the use of the Mental Capacity Act 2005 (MCA).
Right Care
People's care, treatment and support plans did not always reflect their range of needs or promote their wellbeing and enjoyment of life.
People who were known to express emotional distress did not have proactive behaviour strategies in their care records. This meant they did not provide detail on the specific actions staff should take to ensure practices were least restrictive to the person and reflective of a person's best interests.
Right Culture
Care was not always person centred and people were not empowered to influence the care and support they received.
Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.
At the last inspection we found the provider's oversight of the service had not identified some of the shortfalls we found during the inspection process as part of their audits and checks. At this inspection this continued to be the same.
There were systems in place for managing complaints, safeguarding concerns, accidents and incidents. However, these were only carried out for the 12 people we were initially told the provider supported. These did not include the monitoring for the additional 80 people, who received support. The main complaint raised by people and their family members continued to be in regard to lateness, shortness of calls and missed care calls. Staff attending people's homes remained inconsistent at times and their ability to communicate with people and their relatives was poor.
Based on our findings around the continual short, late and missed care calls, there continued not to be enough staff members deployed by the provider to support people. People were supported by staff to take their medicines, however, guidance in place was not clear for staff to follow. Records demonstrated that medicines were not always given as prescribed.
The provider had continued to fail to ensure appropriate pre-employment checks were in place to make sure newly recruited staff were suitable to carry out their role. Some people continued to tell us they felt staff members did not have appropriate skills and knowledge to support them how they wished.
Care plans and risk assessments continued to lack robust and clear guidance, with incorrect or conflicting information. Risks to people were not thoroughly assessed. Risk assessments continued to fail to direct staff on the action they should take in the event of a person becoming unwell or experiencing symptoms of known health conditions.
People continued to tell us their care and support was not always planned in partnership with them and persons close to them. Staff received induction training.
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 16 September 2022).
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations and they had either not implemented or maintained the improvements they said they had made.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has remained Inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see safe, effective, caring, responsive and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sentricare Birmingham on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to; Regulation 9 - Person centred care, Regulation 10 – Dignity and respect, Regulation 11 - Need for consent, Regulation 12 – Safe care and treatment, Regulation 13 – Safeguarding service users from abuse and improper treatment, Regulation 16 – Receiving and acting on complaints, Regulation 17 – Good governance, Regulation 18 – Staffing and Regulation 19 – Fit and proper persons employed, Regulation 20 – Duty of candour at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
The overall rating for this service remains ‘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.