Cera Prescot

Updated 11 October 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

The inspection was carried out by 2 inspectors. An Expert by Experience contacted people and relatives by telephone to gather their feedback on the care provided. 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. Although the previous manager was still registered with the Commission, they were no longer in post. The new manager had been in post a number of weeks and they intended to register with the Commission.

Notice of inspection

The first day of the inspection was unannounced. We provided a short period of notice for the second and third inspection dates.

Inspection activity started on 25 July and ended on 7 August 2023. We visited the location’s office on 25, 28 July and 3 August 2023.

What we did before the inspection

We reviewed information we had received about the service since it registered with the Commission. We sought feedback from the local authority. 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 9 people who used the service and 13 relatives about their experience of the care provided. We spoke with 20 members of staff including the manager, care coordinators, regional manager, field care supervisors and care workers. We reviewed a range of records. This included 15 people's care records and multiple medication records. We looked at 5 staff files in relation to recruitment. We looked at training data and quality assurance records. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 11 October 2023

About the service

Cera Prescot is a domiciliary care agency providing personal care to 263 people at the time of the inspection. The service is based in St Helens town centre and provides support to older people, people living with dementia and people with a learning disability.

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

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.

Right Support: Specific training was provided to ensure staff had the required skills to support people with a learning disability and autistic people.

Right Care: Staff were person centred in their approach which promoted people's privacy and dignity. However, positive behaviour support plans required more detail to guide staff in effectively supporting people.

Right Culture: Leaders lacked awareness of ‘right support, right care, right culture’ guidance.

People were exposed to avoidable risk of harm as systems to ensure the safe and proper management of medicines were inadequate. Medicines to reduce the risk of skin deterioration were not always given as prescribed. This placed people at increased risk of skin breakdown and poor health outcomes. Not all staff had their competency to administer medicines assessed in line with best practice guidance.

Not all records demonstrated risk was effectively assessed, monitored or mitigated. Lessons were not always learnt. The provider took some action to reduce the risk to people following recent incidents involving skin integrity. However, this was not fully robust and we identified that people with similar risks were not receiving the care outlined in their care plans to reduce risks associated with their skin.

The providers monitoring system were inadequate because failures identified at the inspection were not all known or acted upon.

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.

Systems were in place to monitor people’s health, care and support needs, however, recent incidents had highlighted these were not always effective at ensuring concerns with people’s health were identified in a timely way.

Care plans that were in place lacked person-centred detail. People’s care needs were not always effectively reviewed to ensure care plans remained relevant and reflected their needs.

Some people told us they felt confident if they complained, they would be taken seriously. However, some people described communication difficulties with office staff.

Staff were recruited safely and deployed in sufficient numbers to meet people’s needs. People and relatives we spoke with told us staff generally arrived on time, stayed the length of time they should and completed all care tasks. Spot checks were regularly carried out to ensure staff followed good infection control practices when completing care calls.

People told us they were supported effectively with food and drink and staff knew their likes and dislikes. People and relatives provided positive feedback about the skills and experience of staff. People were generally treated with kindness. There was some evidence people were involved in discussions about their care and their feedback about the quality of care was sought.

Staff mostly felt well supported and were guided in their role through induction, shadowing, training and supervision and appraisals.

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 the service under the previous provider was good, published on 4 December 2018. This is the first inspection since the new provider registered with us on 23 September 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

The manager and the provider were responsive to the concerns we shared and took immediate action to reduce the risk to people using the service.

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 breaches in relation to safe care and treatment, consent to care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. 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 is therefore 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.