Background to this inspection
Updated
28 April 2022
The inspection
We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.
Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.
Inspection team
This inspection was carried out by two inspectors and two Experts 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
CRG Home Care – Wandsworth is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service did not have a manager registered with the Care Quality Commission. This means that the provider was legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the inspection
We reviewed information we had received about the service since the last inspection, including information from the provider about important events that had taken place at the service, which they are required to send us. We sought feedback from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
This performance review and assessment was carried out without a visit to the location’s office. We used technology such as telephone and video calls to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation.
Inspection activity started on 21 February 2022 and ended on 7 March 2022
We spoke with seven people who used the service and five relatives.These people used the service between September 2021 and the end of our inspection. We also spoke with seven members of staff including care workers, the branch manager, regional manager and regional director.
We reviewed a range of records. This included people’s care records. We looked at and reviewed multiple documents submitted by the provider. These included policies and other information relevant to the running of the service.
Updated
28 April 2022
CRG- Home Care – Wandsworth is a domiciliary care service and is registered to provide personal care and support to people in their own homes. 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.
At the time of our inspection, 12 people were receiving personal care and support.
People’s experience of using this service
There were continued breaches of regulation in relation to staffing and good governance. The majority of the feedback we received was negative about staff punctuality and the amount of time they spent with people when providing care. People and their relatives commented, “Fed up with CRG saying I have no carers to give you.”, “It was potluck who you got, and what they knew about you. I complained but got no joy from them” and, “No cover when the main carer left.”
Systems were in place to monitor the quality of care people received. However, the electronic system used to monitor staff attendance on their calls did not always work as intended.
People felt unsafe with the care and support provided. Comments included, “On one occasion they were late, and when I rang the office, they said “[carer] couldn’t come back” and “I had a lot of problems getting a carer to come to me on a Sunday.” Staff did not always visit people as planned or stayed the duration of the planned visits to effectively support people.
Staff did not demonstrate sufficient knowledge about safeguarding of vulnerable adults. Risk assessments and management plans were in place which enabled staff to provide care safely. However, we were concerned staffing shortages impacted on managing risks as staff did not always turn up to provide care. People did not always receive the support they needed to take their medicines safely as staff did not always turn up for shifts.
The provider did not foster a culture of learning from incidents and accidents. Accidents were not recorded and monitored and discussed with staff to minimise a re-occurrence. There were instances of missed calls, people receiving unsafe care and the provider’s systems ineffective in monitoring trends to prevent a re-occurrence.
People and their relatives told us staff did not always treat them with dignity and respect. Staff were reported as impatient, rushed people and were always in a hurry. Care and support had not always been delivered. Some staff did not support people with various aspects of their care such as meal preparation, leaving them unwashed, improperly dressed or left them in distress. Staff attended calls much earlier than planned or very late without people’s consent to the changes to their preferences of when their care was delivered.
The provider’s governance and quality assurances systems were not robust and failed to ensure the delivery of safe care and compliance with regulations. Comments from people included, “[Carer] are always in a hurry. They left early”; “[Carers] shot off early. Never stayed the whole duration” and “Sometimes they stayed for 5 minutes instead of 30 minutes”.
People did not always receive consistent and reliable care and treatment. The majority of the feedback we received in relation to the safety of the care provided was overwhelmingly negative. Systems for monitoring staff attendance to care visits, risk management, quality assurance checks and auditing, staffing and supervision were inadequate. The was no registered manager in post and weak oversight on management arrangements by the provider which posed risk of harm to people.
People’s care plans were not always followed to show a person-centred approach to care. People and their relatives told us staff did not provide care tasks as indicated in their support plans. Complaints were not resolved or dealt with effectively to improve people’s experiences. Comments from people included, “[Carers] didn’t understand [person’s] needs and they were aggressive”; “The carer and the manager refused to amend my care plan,” and, “I had a different carer each time.”
Staff knew how to minimise the risk of infection when providing care.
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 was requires improvement (published on 03 January 2021) and there were breaches of regulation. The provider also 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 had not consistently maintained oversight of staffing and quality assurance processes to ensure people received the care they needed. Improvements made since our last inspection were inconsistent and ineffective to ensure safe delivery of care.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
At this inspection we identified continued breaches in relation to ensuring sufficient suitably qualified staff were deployed to meet the needs of people using the service and good governance.
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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.