Archived: Carer House

Carer House is a domiciliary care service providing personal care to people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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 service was providing personal care to two people at the time of the inspection.

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

Risks had not always been managed effectively. People’s risk assessments contained conflicting information. Risks were identified during assessment visits. Actions had not been added to reduce or remove the risks to keep people and staff safe from harm.

Medicines were not always managed safely. The provider’s medicines policy did not relate to the domiciliary care service. The policy related to nursing and residential homes. This meant that staff did not have adequate guidance to carry out their roles safely. Training records showed that new staff had not completed medicines training. New staff told us they were applying creams and lotions.

Staff had not always been recruited safely to ensure they were suitable to work with people. The provider had not carried out sufficient checks to explore staff members' employment history to ensure they were suitable to work around people who needed safeguarding from harm.

Relatives told us that their loved ones had regular staff who they knew well. Their regular staff mostly arrived on time. However, sometimes they were late or they tried to leave early. We made a recommendation about this.

Staff told us they have been supervised and had spot checks of their practice when supporting people with their care needs. Staff supervision records did not evidence that issues identified during spot checks had been discussed and whether there was any further actions or training required as a result of this. We made a recommendation about this.

People were not always treated with dignity and respect. After our inspection a relative contacted us to explain that the lunchtime care staff booked to attend to their loved ones had not arrived. The provider’s call monitoring system had not alerted them to this issue. The provider was unaware of the concerns until the relative rang them. Although a replacement member of staff eventually attended this failure meant that staff did not always treat people with respect as people were left waiting for their care. This is an area for improvement.

The management team were responsible for creating and developing care plans and risk assessments. The provider was not fully aware of AIS. We referred them to information to help them create documents which met people’s communication needs. Care plans were not provided to people in a format which made it easy to read. This is an area for improvement.

At the last inspection we raised that the provider had not appropriately recorded informal complaints which meant that the provider did not have oversight of these and was not analysing trends. This had not improved at this inspection. We made a recommendation about this.

Quality monitoring processes were poor and did not provide the information the provider would need to be assured of the quality and safety of the service provided. The provider did not have sufficient oversight of service. The provider had not taken timely and sufficient action to address the shortfalls identified at the last inspection, which has led to continued breaches of regulations and new breach of regulation relating to risk management, medicines management and recruitment of staff. Records were not always accurate, complete or contemporaneous. There had been no robust audits or checks of the service completed since our last inspection by the provider.

People were not always 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 supported this practice. This is an area for improvement.

A relative gave us positive feedback about the staff who provide care and support to their loved ones. They said, “[Staff member] is very good she is the jewel in their crown, she is helpful, sweet, friendly and engaging. The staff and the service are well intentioned. They are amenable. [staff member] is new she is kind and personable.”

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 service was rated requires improvement at the last inspection on 04 February 2019 (the report was published on 26 March 2019) and there were two 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulations in relation to risk and medicines management, monitoring and oversight of the service, record keeping and recruitment processes. The provider has failed to assess and mitigate risks to people and had failed to manage medicines in a safe way. The provider has failed to ensure systems to operate and monitor the quality and safety of the service were robust. The provider has failed to ensure systems and processes to seek and act on feedback from relevant people were in place. The provider has failed to make accurate and complete records. The provider has failed to operate effective recruitment procedures.

Please see the action we have told the provider to take at the end of this report. 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 rating on their website. 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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

People’s experience of using this service:

Prior to the inspection there was a significant lack of records at the service in that risk assessments had not been completed and care plans lacked details. This meant that people had not always experienced safe care. Some of these issues were addressed during or immediately after the inspection but there were still areas that needed to be improved.

The support people received with their medicines was not always safe. For example, there was a lack of information on what medicines were for and what to do if a person did not take their medicines.

There was enough staff to meet people’s needs. There was some continuity of staffing where people had regular carers and these carers knew people well. However, continuity of care was not always consistent. Some staff were late to calls and some calls were missed.

Staff did not always provide support in a respectful way although when issues were raised about this they were addressed by the provider, but there were still some ongoing concerns.

Staff had received the training they needed however, there were concerns about how staff practiced manual handling on two occasions.

There was a lack of management oversight which meant people did not always receive high quality person centred care. When things went wrong lessons were not always learnt and people’s care plans were not updated. One person was not supported to access support from health and social care professionals following a fall until we raised this as a concern.

People knew how to complain, and the provider regularly met or communicated with people and their relatives. People told us that they felt positive about this. However, some complaints were dealt with as informal complaints and were not always recorded.

Relatives and people were involved in planning their care and in reviews of their care. People had choice about their care and were listened too.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. More information is in the full report.

Rating at last inspection: This is the first inspection of this service.

Why we inspected: This inspection was planned inspection based on the length of time since the service had registered with CQC.

Enforcement: Action we told provider to take is detailed at the end of this report.

Follow up: Following this report being published we will ask the provider to send us information on how they will make changes to ensure the rating of the service improves to at least Good. We will revisit the service in the future to check if improvements have been made.