Archived: Kingston Upon Thames

Kingston-Upon-Thames is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection, there were two people receiving the regulated activity of personal care.

People’s experience of using this service and what we found

People were not always protected against avoidable harm as the nominated individual failed to ensure risk management plans were robust. People’s medicines were not managed in line with good practice. Incidents and accidents were not always recorded, and lessons were not learnt when things went wrong. People were protected against the risk of cross contamination as there were infection control measures in place. People were protected against the risk of harm and abuse and staff received safeguarding training to keep people safe. People received care and support from staff that had undergone pre-employment checks.

People did not receive a service that was well-led. The service continued to be without a registered manager. There continued to be widespread failings in the management of the service. The service continued to be delivered from an un-registered location. Audits undertaken failed to identify issues found during the inspection. The nominated individual failed to ensure there was continuous learning and improvement of the service. Records confirmed people’s views were sought and there was evidence the service worked in partnership with other healthcare professionals.

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 inadequate (published 7 April 2020).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make further improvement. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingston Upon Thames on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, good governance and registration requirements 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 for 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.

Special Measures

The overall rating for this service is '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.

Kingston-Upon-Thames is a is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection, there were two people receiving the regulated activity, personal care.

People’s experience of using this service and what we found

People continued to receive support from a service that was not always safe. The provider continued to fail to ensure recruitment procedures were robust to ensure suitable staff were employed. Risk management plans did not always give staff clear guidance on how to mitigate risks. People’s medicines were not always managed safely and in line with good practice. There continued to be insufficient evidence to determine whether lessons were learnt when things went wrong. Staff were aware of how to identify, respond to and escalate suspected abuse. People continued to be protected against the risk of cross contamination.

People continued to receive care and support from a service that was not effective. Training provided to staff was not always robust and staff did not receive medicines or end of life care training. Staff did not regularly reflect on their working practices as supervisions were sporadic. People’s food and drink requirements and preferences were not recorded. Guidance given by healthcare professionals failed to be documented and there was no evidence guidance was implemented into the delivery of care. People’s consent to care and treatment was sought. The Nominated Individual had devised a pre-admission form for potential new care packages.

People did not receive a service that was well-led. There continued to be systematic failings in the oversight and monitoring of the service. Audits were not robust and did not identify issues we found during this inspection. The service did not have a registered manager in place. There was insufficient monitoring of people’s views to drive improvements. There was insufficient evidence to confirm the Nominated Individual worked in partnership with other stakeholders.

Care plans were not always person-centred. People told us they were not always consulted in the development or review of their care plan. People’s wishes were not always clearly recorded in people’s care plans. People’s end of life wishes were not documented. There had been no complaints received in the last 12 months.

People told us staff were caring, kind, knew them well and treated them with respect. Staff received equality and diversity training. Relatives confirmed staff members encouraged people’s independence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 Inadequate (published 6 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service has been in special measures since 6 August 2019. At this inspection the provider demonstrated insufficient improvements have been made and the service remained in special measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingston-Upon-Thames on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches of the regulations in relation to safe care and treatment, fit and proper persons employed, staffing, good governance, meeting nutritional and hydration needs and registration requirements.

We have also made a recommendation in relation to quality monitoring systems.

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.

Since the last inspection we recognised that the provider had failed to display their inspection rating. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

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 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.

Special Measures

The overall rating for this service is ‘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.

Kingston-Upon-Thames is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the service was providing personal care to four people, all of whom received the regulated activity 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

People did not receive care and support from a service that was well-led. There were systemic and widespread failings in the oversight and management of the service. The managing director failed to notify the Commission in a timely manner that they had changed the registered location of the service. The registered manager was not a visible presence within the service.

People were not protected against the risk of avoidable harm and abuse, as the provider had failed to ensure staff received safeguarding training. Risk management plans were incomplete, or not in place. Guidance for staff to mitigate identified risks was not in place and control measures were inadequate.

People’s medicines were not managed in line with good practice. Staff did not receive medicines management training and failed to maintain accurate records of medicines administered. This meant there was a risk that people did not receive their medicines as intended by the prescribing Pharmacist.

The provider failed to ensure robust and comprehensive pre-employment processes were carried out. Staff files did not always contain two satisfactory references and a Disclosure and Barring Service (DBS) check. The provider had also failed to record people’s visit times; therefore, it was unclear to evidence that people received care and support at the times agreed, in line with their preferences.

There was insufficient evidence documented to suggest lessons were learnt when things went wrong.

People received care and support from staff that had not undertaken training. The provider had failed to ensure staff members had the necessary skills and experience to carry out their roles and responsibilities. Staff did not receive a comprehensive induction upon commencing their role. Records showed that staff did not receive on-going supervision or an annual appraisal, to reflect on their working practices.

People were not always supported to access sufficient amounts of food and drink that met their dietary needs and requirements. Where concerns were identified in relation to people’s food and fluid intake and decline in their health and wellbeing, this was not shared with the relevant healthcare professionals in a timely manner.

People’s consent to care and treatment was not clearly documented.

People did not always receive personalised care and support. The provider failed to carry out comprehensive assessments of people’s needs before they started to use the service. Care plans were inadequate and did not reflect people’s health, medical, emotional or physical needs. Care plans were not regularly updated and also did not document people’s preferences.

People’s records were not maintained in line with good practice. Records were not easily accessible or in place. Some records were locked in cabinets which were irretrievable as the key had been lost. The computer system was not working as the provider had failed to ensure internet access was available.

People and their relatives spoke positively about the staff and described them as caring and supportive. People confirmed they were supported to maintain their independence and had their diverse needs respected.

People were confident concerns and complaints raised would be managed appropriately. The provider was aware of the importance of ensuring a responsive response to all complaints in a timely manner.

People were not always supported to have maximum choice and control of their lives although staff were aware of the importance of supporting them in the least restrictive way possible and in their best interests. The provider failed to provide us with their MCA policy, to ensure it supported good practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 30/09/2016 and this is the first inspection. We had not inspected before now as the provider had not informed us they were providing people with personal care.

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety and the overall oversight and management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We have identified breaches in relation to safe care and treatment, safeguarding people from improper treatment, medicines management, staff training, fit and proper persons employed, good governance, pre-employment checks and recruitment practices, meeting people’s nutrition and hydration needs, person-centred care and registration requirements.

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 for 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.

Special Measures

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 of 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.