Archived: CareBility

Updated 1 November 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 is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13, 15 and 20 June 2018 and was announced. We planned to contact the service the day before the inspection was due to commence. This was as CareBility is a small service, and we wanted to check someone would be available to facilitate the inspection and arrange access to the office and records. However, the registered manager told us they were attending training the day of the planned inspection, and said there was be no-one else available to meet us. We therefore agreed to start the inspection the following day. This meant the service had 40 hours’ notice of the inspection.

Inspection site visit activity started on 13 June 2018 and ended on 20 June 2018. It included phone-calls to people using the service and their relatives, home visits that coincided with visits from people’s care staff, phone-calls to care staff, and visits to the office. We visited the office location on 13 and 15 June 2018 to see the manager and office staff; and to review care records, policies and procedures.

The inspection team consisted of one adult social care inspector and an 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. The expert-by-experience had experience of caring for older adults who had used domiciliary care agencies.

Prior to the inspection, we reviewed information we held about the service. This included the reports produced by CQC’s registration team when they assessed whether we should register the service. We also reviewed feedback we had received from people using the service or their relatives, and information received from local authorities in relation to safeguarding. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We sought feedback from Trafford and Manchester local authority commissioners and quality monitoring teams. Manchester local authority told us they did not commission any care with this service, and Trafford local authority provided us with feedback from monitoring visits they had undertaken. This information raised some concerns in relation to the timeliness of calls and consistency of care staff visiting people. We used this information to help plan our areas of focus during the inspection.

During the inspection we spoke with five people using the service and four people’s relatives by telephone. We also visited two people (including one relative) at their homes during visits from their care staff. We spoke with eight staff members, including the registered manager, an administrative assistant and six care staff. We reviewed records relating to the care people were receiving, including contemporaneous notes (daily records), five care plans and two people’s medication administration records (MARs). We reviewed records relating to the running of a domiciliary care service, including any available audits, training records, supervision records and seven staff personnel files/recruitment records.

Updated 1 November 2018

This inspection took place between 13 and 20 June 2018 and was announced. This was the first inspection we have undertaken of CareBility since the service was registered with CQC in May 2017. At this inspection we identified breaches of the regulations relating to person-centred care, dignity and respect, safe care and treatment, safeguarding, receiving and acting on complaints, good governance, staffing and employment of fit and proper persons. 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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community within the Trafford Local Authority area. It provides a service to older adults and younger adults with a disability. At the time of our inspection the service was providing approximately 237 to 325 hours of care per week to around 18 people. The service was originally registered in Bedfordshire, but shortly after re-located to Manchester due to being awarded a contract with Trafford Local Authority.

There was a registered manager in post who was also the director of CareBility Ltd. 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.

All people we spoke with have experienced issues in relation to staff arriving late for their scheduled calls. Records supported people’s reports and showed calls were frequently significantly late, and could also be cut-short. This had resulted in some people experiencing anxiety, and put people at potential risk of harm. These issues occurred due to difficulties the registered manager had had recruiting sufficient numbers of staff.

Staffing levels had also had an impact on staff members ability to act in caring ways and to promote people’s independence. Whilst this was not the case for everyone we spoke with, we received multiple reports of people feeling rushed, and care staff completing tasks for them as they did not have sufficient time to support people to do things themselves.

Record keeping was poor, including in relation to the administration of medicines. Staff were not always keeping a record when they were proving support to people to take their medicines. We also found evidence that indicated staff had not always supported people to take their medicines as prescribed. This could have a negative impact on their health and wellbeing. The registered manager was not able to provide evidence that all staff administering medicines had received suitable training and had their competence checked.

We found systems in place to help ensure only staff of suitable character were recruited were not robust. There was no evidence that any references had been sought for staff members employed or that other reasonable steps had been taken to provide reassurance that they were of suitable character. Not all staff files contained required information such as proof of identity and a full employment history.

Whilst some risk assessments had been completed in relation to the care people were receiving, we found risk assessment processes were not always adequate. For example, staff told us one person had experienced multiple recent falls. However, there was no record of these incidents and the risk assessment did not reflect this. This would increase the risk that reasonable steps were not taken to help reduce this person’s risk of falls.

There were gaps in the provision of training to existing staff. Some recently recruited staff were providing support to people without having received any training with CareBility. The registered manager showed us that some of these staff had received training in previous employment. However, they were not able to evidence that they had checked whether all staff members were competent to undertake the role, or that they had provided staff with sufficient supervision.

Assessments of people’s needs were carried out when they started using the service. However, there was evidence that these were not always accurate or complete. For example, two people had type two diabetes and this was not known to the registered manager, nor reflected in their care plans. Issues in relation to staffing levels could also affect whether people were supported with meals at suitable times due to staff arriving for calls late.

People told us that a more long-standing group of care staff knew them or their relatives well. However, there was a high turnover of staff at the service, and people did not usually know who would be providing their care.

There was little reflection in people’s care plans of any of their preferences, likes, dislikes or social histories. Some people reported that staff did not read the care plans and were not always aware of the support they or their family member needed.

People who had raised complaints were generally satisfied with the way these had been dealt with, and they felt comfortable raising concerns with the registered manager. However, not everyone felt the action taken had resolved the issues they had raised. Systems for recording and monitoring complaints were not adequate, and the registered manager was not able to locate relevant records for us to review.

At the time of our inspection, no person was receiving end of life care. We noted that staff had not received training in this area, and made a recommendation that the provider sources training in this area.

Arrangements for cover during the registered manager’s absence were unclear and inconsistent.

The registered manager struggled to obtain information and records in relation to the running of the service and care provided. They told us this was due to the software they used crashing and a former employee having deleted records. Systems in place that would help the registered manager monitor the service, such as electronic call monitoring and an electronic care management system were not functioning correctly.

The registered manager was able to show us one example of an audit carried out. This was limited in scope and was not fit for purpose. This meant there was a risk that trends or patterns that would indicate a risk relating to the quality and safety of the service would not be identified and acted upon.

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, will be inspected 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 for 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.

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.