Care-D/UK

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.

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

Information relating to people's individual risks was not always recorded to provide guidance to staff on how to keep people safe. The monitoring of missed and late calls was not robust. Lessons were not always learned to ensure that the quality and safety of the care improved. We have made a recommendation about recruitment processes.

The local authority had alerted CQC to a number of safeguarding incidents which had not been raised with the relevant authorities by the registered manager. Shortly after our inspection, the registered manager confirmed these had now been reported to CQC.

The service's internal systems had not been applied robustly to identify shortfalls in the service and the provider's audits had failed to identify the concerns we found. This meant that improvements required, were not recognised or acted on in a timely way. Improvements were needed to complaints processes.

Staff had access to appropriate personal protective equipment (PPE) to help prevent the spread of infection. Staff were trained and competent in their role. Staff received supervision and appraisals to monitor their performance and identify any learning needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

People spoke positively about the staff that supported them. People’s needs had been assessed and their wishes and preferences were known and respected.

This service was registered with us on 19/03/2018 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about missed and late visits. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements.

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.

We have identified the following breaches at this inspection.

Regulation 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Systems were either not in place or robust enough to ensure that appropriate actions had been taken following safeguarding concerns. This placed people at risk of harm.

Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Systems to assess and manage concerns and risks were not robust to keep people safe. This placed people at risk of unsafe care.

Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Systems and processes were not robust enough to demonstrate quality and safety were effectively managed.

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