Background to this inspection
Updated
24 November 2016
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 between 31 August and 12 September 2016. The inspection involved visits to the agency’s office on 31 August and 12 September 2016. On 31 August 2016, we also met with some of the care workers. Between 31 August and 12 September 2016, we spoke with people, their relatives and care workers on the phone. The provider was given two working days’ notice of the inspection because the location provides a care service in people’s homes. The inspection was undertaken by an inspector and two experts 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.
Before our inspection we reviewed the information we held about the agency, including previous inspection reports and the provider’s action plan following the previous inspection. We reviewed the provider’s information return (PIR) and responses from questionnaires sent by us to people, their relatives, staff and community professionals. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.
We spoke with 27 people who received a service and their relatives. We spoke with 10 members of staff, the registered manager and three senior managers who worked for the provider.
During the inspection we looked at 10 people’s records and nine staff recruitment, supervision and spot check records. We also looked at training records, quality audits and policies and procedures.
Updated
24 November 2016
This inspection took place between 31 August and 12 September 2016. The inspection involved visits to the agency’s office and telephone conversations with people, their relatives and staff between the beginning and end dates. The agency were given two working days’ notice of the inspection. The agency provided 133 people with care in their own home. Most were older people or people who lived with long-term medical conditions.
People received a range of different support. Some people received infrequent visits, for example weekly support to enable them to have a bath. Other people needed more frequent visits, including daily visits, and visits several times a day, to support them with their personal care. This could include use of aids to support their mobility. Some people needed support with medicines and meal preparation. Some people needed visits from two care workers to support them with their personal care.
Care at Home – Crowborough, supplied a service to people in the small Sussex town of Crowborough, and rural areas in a wide catchment area around the town. The provider was Care at Home Services (South East) Limited who provides domiciliary care services to people from different offices across the South East of England.
Care at Home – Crowborough had a registered manager in post. 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.
The service was last inspected from 16 November to 15 December 2015. At that inspection, we found people’s health and welfare was not protected because the provider did not have systems, which operated effectively, to assess, monitor and improve the quality of the service. The provider also did not maintain an accurate and complete record in respect of each person, staff and management of the service. The provider did not effectively seek, evaluate and act on feedback from relevant persons, to improve service provision. We issued a Warning Notice following the inspection and required the provider meet this Notice by 30 April 2016. Relevant improvements had not been made by this inspection.
At the last inspection we found care was not provided to people in a safe way. This was because the provider had not assessed risks to people’s health and safety and was not doing all that was practicable to mitigate such risks. This was a breach of Regulation and we required the provider take action to address this. The provider stated in their action plan that they would have addressed the breach by 30 June 2016. At this inspection, a number of areas had not been addressed. These related to ensuring people had relevant assessments of safety, which were reviewed when necessary. The provider also continued not to take all relevant action to ensure the safety of people in relation to medicines and prevention of risk of infection. The provider had addressed some areas.
At the last inspection the provider had not ensured they had an effective and accessible system for identifying, receiving, recording, handling and responding to complaints. This was a breach of Regulation and we required that the provider take action to address this. The provider stated in their action plan that they would have addressed the breach by 30 June 2016. At this inspection, we found the provider had not taken all relevant action to ensure people’s complaints and issues of concern were documented or that all issues of concern raised with them had been acted upon.
At this inspection we found the provider had not identified they were not working within their own policy on the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The provider had not ensured where they needed to provide care which might restrict people, that relevant assessments were in place and there was evidence that such care provision had only been provided in people’s best interests.
At the last inspection we found people were not protected because the agency’s recruitment systems did not ensure staff were of good character, and had the necessary qualifications, competence, skills and experience. We issued the provider with a Warning Notice in relation to this matter and required they met this Notice by 30 April 2016. At this inspection we found the provider had taken necessary action to ensure they had met the Notice.
People were not protected because the provider was not ensuring they always had suitably qualified, competent, skilled and experienced care workers who had received appropriate support, training and supervision as necessary. We issued the provider with a Warning Notice in relation to this matter and required they met the Notice by 30 April 2016. At this inspection we found the provider had taken action and had addressed the Notice. People and staff also confirmed staff were fully trained and supported in their roles.
People commented positively on the caring nature of the staff and said staff ensured they were safeguarded. People said staff contacted relevant healthcare professionals when they needed support from them, including in an emergency. They said where they needed support with meals, this took place in the way they wanted. People and staff said there were enough staff employed, so people did not experience missed visits.
During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this provider remains ‘Inadequate’. This means that it remains in ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.
CQC are taking enforcement action to ensure that Care at Home Services (South East) Limited provide safe and effective care.