Archived: Care at Home Services (South East) Ltd - Crowborough

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.

We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We identified some gaps in the recording of care plans which could place people at risk of receiving inappropriate care and support. People told us that there were sometimes late and missed care visits. This could place the welfare and safety of people who used the service at risk. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

Care staff had received the training they needed to support them in their roles. However, a number of staff expressed concerns about a lack of communication and coordination from the office. They told us that they did not feel properly supported in managing their workload. This meant that staff were not fully supported to deliver care and treatment safely and to an appropriate standard. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People told us that they were happy with the care provided by care staff. Comments included "They are kind", "They take the time to talk to me" and "I am happy with the care". The staff we spoke with demonstrated a commitment to making sure people were looked after.

Is the service responsive?

People's needs were assessed and reviewed. A number of people told us that support had not been provided in accordance with their preferred times. They also said that there they were not always kept informed of changes or delays to their care schedule. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

The manager demonstrated a good understanding of the requirements of their role and was aware of areas which required improvement. People who used the service were given opportunities to express their views. However, people told us that they did not always feel their concerns were taken seriously.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from abuse and cared for in a safe and inclusive environment. We also noted that people were cared for, or supported by, suitably qualified, skilled and experienced staff. In addition, the provider had an effective system to regularly assess and monitor the quality of service that people receive.

People told us that care and support had been well managed. One person said "If I ring up the response is good.' Another person told us "I have regular carers at the same time every day."

There was evidence in the care plans that needs and risk assessments had been completed in detail. This enabled care workers to support individuals in a safe and appropriate way. Records showed that there were robust recruitment procedures to make sure staff employed were fit to carry out their work.

We found that the service had regularly assessed and managed risks relating to the health, welfare and safety of people receiving a service for example by carrying out spot checks on staff while they were undertaking visits.