Background to this inspection
Updated
7 September 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. 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 Care Act 2014.
Inspection team
The inspection was carried out by one inspector and two Expert by Experiences. 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.
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.
Notice of inspection
We gave the service 24 hours’ notice of the inspection due to the COVID-19 pandemic to ensure we had prior information to promote safety. Inspection activity started on 29 June 2021 and ended on 6 July 2021. We visited the office location on 29 June 2021.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. 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. We used all this information to plan our inspection.
During the inspection
We spoke with 24 people who used the service and 11 relatives or advocates about their experience of the care provided. We spoke with 14 members of staff including the registered manager, head of homecare, director of quality and compliance, care staff, a care coordinator and an assessor. We also spoke with one health care professional.
We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at four staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
7 September 2021
About the service
GreenSquareAccord Oldham is a domically care agency providing personal care to 312 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
Risks relating to people’s health conditions were not always assessed: whilst some people had risk assessments in place, others with specific health conditions did not. We found numerous instances where medicines records were not completed.
The service had a high number of staff vacancies and records indicated there were a number of late calls. Staff told us they felt the service was under-staffed. Staff were recruited safely into the business. Safeguarding policies and procedures were in place and staff were using appropriate personal protective equipment during the delivery of care.
Audits were in place, however when risk was identified (in areas including staffing and gaps in recording of medicine administration), the service had not been able to rectify these issues. The speed of improvements needed had been impacted by operational challenges relating to COVID-19, difficulties in recruiting new staff and specific contractual requirements. Feedback about management was mixed. The registered manager understood their responsibilities under the duty of candour to be open and honest. Appropriate referrals had been made to CQC and safeguarding. 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 good (published 13 September 2018).
Why we inspected
The inspection was prompted in part due to concerns received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
The provider had taken various steps to mitigate some of the risks identified and an internal action plan had been put together to ensure improvements were made.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for GreenSquareAccord Oldham on our website at www.cqc.org.uk.
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 have identified breaches in relation to safely assessing risk relating to health conditions and recording gaps in medicines administration, good governance and staffing at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.