Care-D/UK

Updated 22 June 2022

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by two inspectors and one Expert 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 houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. At the time of our inspection there was a registered manager in post. The registered manager is also the owner and provider of this service.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. Inspection activity started on 26 April 2022 and ended on 10 May 2022. We visited the location’s office on 29 April 2022.

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 and professionals who work with the service. The provider did not complete the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 21 March 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with eight people to gain their views about the service. We also spoke with six people’s relatives or advocates. We spoke with seven members of staff, including care workers, senior care workers, the finance manager, the administrator, and the registered manager, who is also the provider. We reviewed three people’s care plans, two staff recruitment files and a variety of policies, procedures, audits and other systems used for managing the service.

Updated 22 June 2022

About the service

Care-D/UK is a home care agency providing personal care to people living in their own houses and flats. At the time of our inspection there were 25 people using the service.

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. The provider told us 14 people were supported with personal care.

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

Staffing levels, deployment and monitoring of visits were inadequate to meet people’s assessed care and support needs. There was limited action taken to reduce the impact on people of regular missed or late calls. Some risk assessments were insufficiently detailed. There was no analysis of safeguarding themes and trends to reduce the risk of reoccurrence. Staff were not always recruited safely. People told us staff did not always wear personal protective equipment (PPE) in line with government guidance. It was not demonstrated lessons had been learned from the last inspection.

Whilst people received an assessment of their needs and preferences when they joined the service, it was not demonstrated how people’s need were consistently met following frequent late, missed and shortened visits. People gave mixed feedback about care workers. Whilst some were described as kind and caring, this was inconsistent. The provider did not schedule visits in a way that always enabled staff to provide a caring service. People described being rushed, having to rely on family and friends, or trying to carry out their own care unsupported when staff did not arrive.

Care plans were in place and being reviewed. However, records were not always completed, which meant changes to people’s care needs might be missed. The provider logged and responded to complaints. However, there was no effective action to address the main underlying cause of complaints which were late, missed and shortened calls.

Systems and processes for governance, oversight and improvement were not comprehensively established or embedded. Actions the provider told us had been taken since the last CQC inspection had not all been implemented effectively. Audits did not always identify concerns or show the action to take as a result. Mechanisms for engaging with people and seeking feedback about the quality of the service were not effective.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff received training to support them in their role, including for specific health needs such as diabetes and epilepsy. Staff received ‘spot check’ supervisions whilst carrying out visits. The provider worked with other health and social care professionals. Staff could explain the steps they should take to support a person’s privacy and dignity. A policy was in place for meeting the Accessible Information Standard and for end of life care. Most staff told us they felt supported by management.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 January 2021) 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. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider review recruitment files to make sure safe recruitment checks were carried out. At this inspection we found the provider had not improved recruitment processes.

This service has been rated requires improvement or inadequate for the last two consecutive inspections.

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse or improper treatment, staffing numbers and deployment, recruitment practices and governance and oversight of the service.

We issued two Warning Notices as a result of our findings 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.