9 January 2024
During an inspection looking at part of the service
Adopt Healthcare Ltd is a domiciliary care service that provides personal care and support for people in their own homes. At the time of the inspection the service was supporting 2 people with personal care.
People’s experience of using this service and what we found
Serious shortfalls were identified which impacted on the safety and quality of care people received.
Sufficient improvements had not been made to address the issues we raised at our last inspection. This included concerns in relation to the management of risk, medicines, staff recruitment, consent and good governance. We also identified people were not being protected from the risk of abuse.
The provider was kind, caring and knew people well. However, their oversight and management of the service was not safe or effective. The provider demonstrated a lack of understanding of many of the key principals required to ensure they delivered a good service. Their governance systems were not robust and had failed to identify the significant and widespread issues identified at this inspection.
People were not kept safe from the risk of harm. The provider did have robust processes in place to ensure lessons were learned when accidents and incidents occurred. Medicines were not managed safely.
Care plans and risk assessments did not contain the information staff needed to deliver safe, effective, and personalised care.
People were not 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 did not support this practice.
We could not be assured people received effective nutritional support. There was no evidence of involvement from other health professionals involved in people’s care.
Staff recruitment processes were not consistently safe. Staff received an induction and ongoing supervision and support from the provider. The ineffective monitoring of staff training meant it was difficult to confirm whether staff had received appropriate training.
People were supported by consistent staff who knew them well. People and their relatives told us overall they were happy with the care staff provided however some concerns were raised regarding how staff supported one person. We informed the local authority safeguarding team about this.
Staff followed good infection control practices.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.
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 last rating for this service was inadequate (published 15 August 2023) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found the improvements made were minimal and the provider remained in breach of regulations.
This service has been in Special Measures since 15 August 2023. The service continues to be rated inadequate overall. Therefore, this service remains in Special Measures.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.
Following our inspection, the provider sent us some additional information to demonstrate what actions they had taken to mitigate the risks to people. Our review of this information showed these improvements were still not effective in addressing the issues identified during this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Adopt Healthcare Ltd. on our website at www.cqc.org.uk.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains inadequate. This is based on the findings at this inspection.
Enforcement
We have identified continued breaches in relation to safe care and treatment, staff recruitment, good governance and compliance with the Mental Capacity Act. We also identified a new breach in relation to safeguarding.
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.
Follow up
We will 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 continue to monitor information we receive about the service, which will help inform when we next inspect
The overall rating for this service is ‘Inadequate’ and the service remains 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 rating, 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.