Archived: Prayngel Healthcare Limited

Updated 12 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 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 Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

This announced inspection was carried out on 11, 12, 17 and 23 October 2017. The inspection was announced to ensure our inspection could be facilitated on that day. The inspection team consisted of an adult social care inspector from the Care Quality Commission (CQC) and an expert by experience who spoke with people who used the service and their relatives via telephone during the first day of the inspection. An expert by experience is someone who has personal experience of caring for people, similar to this type of service. An additional adult social care inspector was part of the inspection on the fourth day of our visit.

Before the inspection we reviewed any information we held about the service in the form of notifications about any safeguarding or whistleblowing information we had received, previous inspection reports and any complaints about the service. This helped us determine if there might be any specific areas to focus on during the inspection.

At the time of the inspection the service provided care and support to approximately 19 people in the Trafford area of Greater Manchester. As part of the inspection we spoke with the branch manager, the care co-ordinator, six people who used the service, three relatives and three care staff. This was to seek feedback about the service provided from a range of different people and help inform our inspection judgements.

During the inspection we viewed six care plans, five staff personnel files and four medication administration records. We also reviewed other documentation relating to the running of the service, such as satisfaction surveys, complaints, spot checks/observations, policies and procedures and quality assurance audits.

Updated 12 January 2018

This announced inspection was undertaken on 11, 12, 17 and 23 October 2017. We gave the provider two days notice to ensure it could be facilitated on that day. This was the first comprehensive inspection we had undertaken at this location since the provider registered this location with CQC in August 2017. At the time of the inspection there were 19 people using the service.

Blue Lantern Care Agency is a domiciliary care service located in Salford but predominantly provides care to people in their own homes in the Trafford area. The majority of care packages are funded through Trafford Council.

We carried out this inspection due to receiving a number of concerns about the quality of service being provided relating to missed/late visits, poor care and medication errors. During this inspection we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to person centred care, safe care and treatment, safeguarding people from abuse, good governance and staffing (two parts).

The provider had not submitted notifications to CQC in line with statutory requirements. The service had also moved offices without following the correct CQC process of submitting an application. We are addressing these issues outside of the inspection.

There was a registered manager in post but they were not present during our inspection visits. There was also a branch manager who was involved with the day to day running of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We looked at the systems in place to safeguard people from abuse. There was a safeguarding policy and procedure but this provided inaccurate information for staff to refer to such as a different local authority area and a safeguarding lead who did not even work for the service. We also found instances where unexplained marks and bruising had been identified on people by staff, however safeguarding referrals had not been made so that further investigations could take place.

We reviewed medication and looked at four MAR (Medication Administration Records) charts of people who used the service. We found MAR were not always being completed accurately by staff, with gaps noted on each of the records we viewed. This meant we could not determine that people had always received their medication safely.

At the time of our inspection, recruitment of staff was ongoing. The branch manager told us that at present, they didn’t feel there were enough staff working for the agency, with both themselves and the care coordinator assisting with care calls where necessary. Both people who used the service and relatives raised concerns with call times, stating staff were not always punctual. The service did not use a call monitoring system to check if care calls were being completed as required and that staff were on time. Missed visits had also occurred, with family members being required to deliver care. This meant management could not demonstrate oversight of calls that were late or missed.

Risk assessments were not always in place with regards to people’s care and support. One person had been having increased falls since returning from hospital. Another incident had occurred with a person’s catheter where it had been attached too tightly to their leg causing a loss of circulation. However, risk assessments were not in place to demonstrate how these risks would be prevented from happening again in the future.

We looked at the training staff received to support them in their role and viewed the training matrix and found staff had received training in areas such as; safeguarding, infection control, equality and diversity, fire safety and moving and handling. One person who used the service needed a catheter but we found staff had not received training in this area.

Training relating to the completion of MAR sheets was listed on the matrix but had not been undertaken, which was an area of concern found during our inspection. We were also aware two people receiving support had a diagnosis of dementia, however dementia awareness training had not been provided. Training relating to diabetes had also not been taken, despite a person using the service presenting with these care needs.

Staff provided support to people to eat and drink as necessary. This included assistance with food preparation and ensuring people were left with something to drink when their call had finished. Where staff needed to provide direct support at meal times, the people we spoke with said this was done well.

Each person who used the service had a care plan in place, with a copy held at both the office and in their own home. We found instances where care plans had not been updated following changes to people’s care needs and reviews of their care needs had not yet taken place.

The service sent satisfaction questionnaires to people who used the service and their relatives, asking them for their views and opinions of the service they received. We noted some of the responses were poor where people had been dissatisfied; however we were unable to see how this information had then been used to improve the quality of the service received.

There was a complaint’s procedure in place, this procedure enabled people to state if they were unhappy with the service. The people we spoke with were aware of how to make a complaint. The service also collated positive compliments that had been made based on people’s experiences.

Since the service registered this new location with CQC in August 2017, we had not received any statutory notifications directly from the service. The only information we had received had been sent by other healthcare professionals. During the inspection we found several safeguarding incidents had been raised against the service, however statutory notifications had not been submitted in line with the provider’s statutory requirements. The service had also been relocated to a new address, however had done this without going through the correct CQC process by submitting an application to change their location.

The service had quality assurance systems in place such as spot checks/observations of staff and audits of medication. However these systems were not fully effective. For example, there were no audits of potential safeguarding concerns, ensuring notifications were being sent to CQC and staff training which had been some of the concerns identified during the inspection.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, we will be inspecting again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate in any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.