Archived: Carepath Recruitment Ltd

Updated 22 March 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 checked 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.

The inspection was prompted in part, to gain an updated perspective on the quality of the service, in line with our enforcement procedures. The inspection also took place, as the service was rated inadequate overall and was placed into special measures, at the last inspection. As such, it is the commission’s responsibility, to ensure provision has not worsened and further enforcement action is required, to keep service users in receipt of support from the service safe.

This inspection took place on the 20 and 21 April 207 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in to support the inspection.

The inspection team consisted of two adult social care inspectors. Prior to the inspection, the lead inspector reviewed the available information the commission held on the service, including reviewing the last report and any outstanding actions. We requested any intelligence from our stakeholder group, including the Local Authority and local health watch team.

During the inspection, we reviewed the records the staff used to guide them, in supporting the service users using the service. This included, reviewing the medicine administration records for three service users, one of whose home we visited.

We spoke with the registered provider and registered manager, the care coordinator and five carers including a senior carer. We spoke with four service users and reviewed seven service users’ care plans. Four service user’s plans were reviewed both within the office and within the person’s own home.

We also looked at five staff personnel files, reviewed the service’s training information and assessed the suitability of recruitment information. The service’s policies and procedures were reviewed to ascertain their implementation by the service’s staff.

Updated 22 March 2018

We inspected this service on the 20 and 21 April 2017. We also attended the office on the 24 April to provide feedback to the registered manager. The inspection was announced to ensure the provider had someone available in the office to assist the inspection team.

Carepath Recruitment Ltd is a domiciliary care agency. The agency provides personal care to service users in their own homes. The service supports both children and adults with varying degrees of support needs. The agency is located in the town centre area of Preston, close to the town’s bus station. The office space is shared with the other part of the business which is a recruitment agency.

At the time of the inspection there were nine service users receiving support from Carepath Recruitment: four children and five adults. Following the last inspection a voluntary agreement had been made between the provider and CQC to not agree any further packages. It was discovered whilst planning for this inspection, that the provider was supporting three more service users than declared at the last inspection and had agreed a further two since the last inspection. The provider had been asked directly via email the service users they were supporting and again did not declare all of the packages.

On the day of the inspection the provider, who is also the registered manager was not available to assist the inspection team. The provider had recruited a care coordinator who was available to the inspectors. We asked the care coordinator who Carepath recruitment were providing support too and again not all the packages were declared. It was only when names were given to the care coordinator it was confirmed the service users were being supported. When we discussed this with the provider and registered manager, we were told, it was a mistake and they thought the commission meant for them to only declare the services the commission were aware of. Following this inspection an urgent Notice of Decision was served onto the provider to ensue no further packages of care were agreed and that the current packages did not increase in hours.

The service was last inspected in August 2016 where six breaches of the regulations were found. The home was rated as inadequate overall and placed into special measures. The key questions of safe, effective and well led were previously rated as inadequate, responsive and caring were rated as requires improvement. At this inspection we found the quality of provision had further declined and the key question of responsive was now also rated as inadequate, with caring remaining as requiring improvement. At this inspection we saw some improvements had been made to some of the regulations and one breach to Regulation 10 was now met. However we noted continued breaches to five of the regulations and breaches to four further regulations. We also judged the provider to be in breach of one of the registration regulations.

There was 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 had legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of this and the previous inspection the registered manager was also the sole director for the registered provider.

At this inspection we found some improvements had been made to some areas, namely at the last inspection there were no care plans for some service users in receipt of support. We found care plans had recently been completed for all service users being supported but we were concerned about the quality of those care plans. At the last inspection staff told us, they did not receive support or supervision. It was clear the new care coordinator had begun to undertake supervisions with some of the staff. When we spoke with staff we were told these were arranged when there was an issue or when they went into the office, time would sometimes be taken to complete supervision. We could not see a definitive timescale for the expectation of supervision but they had begun which was an improvement from the last inspection.

At the previous inspection we found that service users were not involved with the development of their care plans and did not influence the support they received. At this inspection we found that review meetings had begun and they included any concerns the family or service user had shared with the provider. However they were not structured and had only begun in the last month prior to the inspection so the impact of these could not be seen. We did not note any changes to service user’s care plans as a result of the reviews.

As at the last inspection we found risks and service user’s support needs were not always assessed appropriately. We found the same at this inspection. Medication risk assessments were simply a list of the medications rather than an assessment of the risks associated with the person taking or not taking the medication. There was no person centre information in the assessments to determine any risks with any aspect of service user’s medication. We found other risks which were identified within initial assessments or daily records were not assessed and plans of care were not developed to support service users with their specific needs.

Medication was again poorly managed and various gaps in the MARs (Medication Administration Records) were evident. These were not picked up via audits and the reason for the gaps was not explored. This could have meant service users had missed their medication.

At this inspection we visited the property of one of the children in receipt of support and three of the adult packages. In all the homes we visited we found contradictory information within the care plan held in the office and the one held in the home. Service users were not protected by up to date, appropriate and reflective care plans and assessments.

We found other areas of service delivery had not changed since the last inspection including poor audits of the service provided and a lack of collation of accidents and incidents to identify themes and trends. This would enable the service to reduce any identified associated risks.

There was not any evidence at this or the previous inspection to support the implementation of the Mental Capacity Act 2005. We were aware of service users who were restricted in their daily activity and applications had not been made to the court of protection to ensure this was done legally. We were also aware of service users who did not have the capacity to make informed decisions or give consent and the service had not assessed how to best support these service users.

We found staff had not all received appropriate training for the role they were undertaking. Supervision had recently begun, but there were no systems in place to test the competency of the staff. This was in respect of their duties including moving and handling, medication administration and the management of more complex needs. We had concerns in all three of these areas.

Staff were not recruited safely. Whilst we saw appropriate checks via the DBS, we noted references were not validated and some application forms held miss information that was not identified and assessed, to determine staff suitability to their role.

We were told by staff that things had recently improved and whilst the care coordinator told us some staff were now on permanent contracts, in the five files we reviewed all staff remained on zero hours contracts. Service users we spoke with, spoke well of the staff and staff we spoke with appeared motivated to complete their role as well as they could.

We discussed at length the requirements of the regulations and the need for robust systems of quality audit to drive improvement. At the last inspection concerns were noted and the provider was informed of what was required to address the issues. The provider had developed action plans for the breaches noted within the report. Areas of a higher concern had been detailed within other correspondence to ensure the provider made improvements with the service. We found the provider had not taken the steps, they had identified as required within the action plans, presented to the commission to address the identified breaches. This included the completion of capacity assessments for all service users using the service, supervision of staff who had made errors on medication records and staff administering medication to have their competence checked. Omissions also included; the inclusion of family and service users using the service in development and review of care packages and that service users could choose their care worker. No one we spoke with confirmed that this happened.

We found steps had been taken to better support one person in a more dignified and respectful way, but we still had concerns about the management of this package. A robust system of quality audit had not been developed or implemented. Without this it is clear improvements could not be measured by the provider. We continued to find the leadership of the organisation was not engaged with the delivery of registered activities and the regulations that underpin them.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were namely around; safe care and treatment, need for consent, good governance, person-centred care and staffing. We also found additional breaches in respect of managing complaints, safeguarding, the recruitment of staff and a failure to display the last inspection ratings. Breaches to the registration regulations were also noted in respect of the submission of notifications.

The overall rating for this provider remains ‘Inadequate’. This means that it will remain in ‘Special measures’ by CQC.