Background to this inspection
Updated
28 January 2021
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. This inspection was planned to check 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 Care Act 2014.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was not present during the inspection visit.
Inspection team
This inspection was conducted by one inspector 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
This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides services to younger and older adults.
Notice of inspection
This inspection was unannounced. Inspection activity started on 03 December 2020 and ended on 11 December 2020. We visited the office location on 03 and 09 December 2020.
What we did before the inspection
We sought feedback from the local authority and professionals who work with the service. 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
We spoke with the nominated individual who is the owner, the acting manager, two office staff, and eight care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We looked at nine people’s care records. We looked at eight staff files in relation to recruitment and staff supervision records. Multiple records relating to staff rotas and care visit records, the management of the service and a variety of policies and procedures developed and implemented by the provider were reviewed during and after the inspection.
After the inspection
We continued to seek clarification from the provider to corroborate evidence found. We looked at training data and quality assurance records and staff rotas. We spoke to professionals from the local authority, 43 people who used the service and 15 relatives via telephone to seek their views about the care.
Updated
28 January 2021
About the service
Complete Care Services (Preston) provides personal care to people living in their own homes in the community. Not everyone who used the service received personal care. Care Quality Commission (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 the service was providing personal care to 80 people.
People’s experience of using this service and what we found
People did not always receive consistent and reliable care and treatment. We received mixed responses in relation to the safety of the care provided with overwhelmingly negative feedback. The providers’ risk management practices were not robust, this included the assessment of risks associated with financial abuse, self-neglect and infection prevention. People’s medicines were not always managed safely. Safeguarding procedures and staff disciplinary procedures were not always followed to ensure allegations were robustly investigated. The provider had not implemented safe recruitment practices needed to protect people from unsuitable staff.
People’s human rights were not always upheld. People and their relatives gave us mixed responses regarding staff’s attitude. Some told us they were not always treated with dignity and respect, some staff were impatient, rushed them and were always in a hurry. Planned delivery of care had not always been carried out. Some staff had visited but not assisted people as planned this included meal preparation, leaving them in soiled bedding and not summoning for medical assistance where a person had deteriorated. Staff visited people late and at times assisted them to bed too early against their wishes.
The provider’s governance systems did not support the delivery of safe care and compliance with regulations. Systems for monitoring care visits, maintaining care records, risk management, auditing, staff and supervision were inadequate. The registered manager was not adequately supervised to check how they were managing the service and managing the delivery of care. People and staff did not always feel listened to by management. We made a recommendation about engaging people.
People’s care plans were not always followed to show a person-centred approach to care. Records of care completed were not always an accurate reflection of the actual care provided. People’s complaints were not dealt with effectively to improve people’s experiences. Comments from people included; “There is no point of complaining, nothing is done about it” and, “We have raised concerns a number of times, but nothing changes.”
People’s care was not always delivered in line with guidance. Staff did not always visit people as planned or stayed the duration of the planned visits to effectively support people. People were not adequately supported to meet their dietary needs. We made a recommendation about dietary support. The registered manager had supported staff with a range of training; however, improvements were required to ensure staff received training on the use of personal protective equipment.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection:
At the last inspection the service was rated good (published 4 August 2018).
Why we inspected
This was a planned inspection based on the previous rating.
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.
We have identified breaches in relation to risk management, safeguarding people, person-centred care, dignity and respect, good governance, complaints management, record keeping at this inspection. 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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.