Sentricare Birmingham

About the service

Sentricare is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection the provider initially told us there were 12 people using the service. However, due to information being shared with us by a whistle-blower, we later established we had been provided with incorrect information by the provider. Based on additional information shared with us by the provider, they provided a list of 88 people using the service. Again, during the inspection, we found this number was incorrect and had increased to at least 92 people using the service. We are still seeking clarification from the provider to establish the accurate number of people using the service. The service was providing support to children, older and younger adults, people living with; dementia; learning disabilities; autism; mental health conditions; physical disabilities and sensory impairments.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People's experience of using this service and what we found

The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured of the choices and involvement of people who used the service in their care and support. Initially the provider told us they did not support any people who lacked capacity, had a learning disability or autism or expressed emotional distress. However, we identified that there were several people being supported by the provider who had multiple needs including those with a learning disability.

Right Support

People were not always supported to have maximum choice and control of their lives as they told us they were not routinely involved in care reviews and when they had raised concerns these had not been addressed. Staff did not always support them in the least restrictive way possible and in their best interests.

We found guidance within peoples care plans for staff members to follow when supporting autistic people or people with a learning disability who may express distress or frustration, was inadequate. Care plans and risk assessments did not provide staff with information on how to respond to such expressions of distress, how to de-escalate or how to provide positive re-enforcement.

Staff training and record keeping needed to be improved in relation of the use of the Mental Capacity Act 2005 (MCA).

Right Care

People's care, treatment and support plans did not always reflect their range of needs or promote their wellbeing and enjoyment of life.

People who were known to express emotional distress did not have proactive behaviour strategies in their care records. This meant they did not provide detail on the specific actions staff should take to ensure practices were least restrictive to the person and reflective of a person's best interests.

Right Culture

Care was not always person centred and people were not empowered to influence the care and support they received.

Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

At the last inspection we found the provider's oversight of the service had not identified some of the shortfalls we found during the inspection process as part of their audits and checks. At this inspection this continued to be the same.

There were systems in place for managing complaints, safeguarding concerns, accidents and incidents. However, these were only carried out for the 12 people we were initially told the provider supported. These did not include the monitoring for the additional 80 people, who received support. The main complaint raised by people and their family members continued to be in regard to lateness, shortness of calls and missed care calls. Staff attending people's homes remained inconsistent at times and their ability to communicate with people and their relatives was poor.

Based on our findings around the continual short, late and missed care calls, there continued not to be enough staff members deployed by the provider to support people. People were supported by staff to take their medicines, however, guidance in place was not clear for staff to follow. Records demonstrated that medicines were not always given as prescribed.

The provider had continued to fail to ensure appropriate pre-employment checks were in place to make sure newly recruited staff were suitable to carry out their role. Some people continued to tell us they felt staff members did not have appropriate skills and knowledge to support them how they wished.

Care plans and risk assessments continued to lack robust and clear guidance, with incorrect or conflicting information. Risks to people were not thoroughly assessed. Risk assessments continued to fail to direct staff on the action they should take in the event of a person becoming unwell or experiencing symptoms of known health conditions.

People continued to tell us their care and support was not always planned in partnership with them and persons close to them. Staff received induction training.

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 16 September 2022).

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 provider remained in breach of regulations and they had either not implemented or maintained the improvements they said they had made.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has remained Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see safe, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sentricare Birmingham on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to; Regulation 9 - Person centred care, Regulation 10 – Dignity and respect, Regulation 11 - Need for consent, Regulation 12 – Safe care and treatment, Regulation 13 – Safeguarding service users from abuse and improper treatment, Regulation 16 – Receiving and acting on complaints, Regulation 17 – Good governance, Regulation 18 – Staffing and Regulation 19 – Fit and proper persons employed, Regulation 20 – Duty of candour at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service remains ‘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.

Sentricare is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection there were 282 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

The provider's oversight of the service had not identified some of the shortfalls we found during the inspection process as part of their audits and checks.

There were systems in place for managing complaints, safeguarding concerns, accidents and incidents. However, we found these were not robust and feedback from people and relatives on how the provider dealt with complaints and concerns was very poor. The main complaint raised by people and their family members was the lateness, shortness of calls and missed care calls. We found from call records and rota’s that short, late and missed calls were the occurring. Staff attending people’s homes at times were inconsistent and their ability to communicate effectively was poor, this was due to language barriers. People felt the communication with the office staff and their responses were unsatisfactory.

People were not protected from abuse because the systems and processes in place were not robust to keep people safe. Staff we spoke with were aware of their responsibilities to keep people safe.

Based on our findings around the continual short, late and missed care calls, there were not enough staff members deployed by the provider to support people. People were supported by staff to take their medicines, however, guidance in place was not clear for staff to follow. Records demonstrated that medicines were not always given as prescribed.

We found the provider was not adhering to current Infection Prevention and Control guidance. They had no oversight of the staff to ensure they were carrying out COVID-19 tests or following guidance for the correct safe use of Personal Protective Equipment (PPE).

There were not always appropriate pre-employment checks in place to make sure newly recruited staff were suitable to carry out their role. Many people felt staff members did not have appropriate skills and knowledge to support them how they wished.

Care plans were not fully personalised, and information contained within them had not been reviewed and updated to reflect people’s current support needs. Risks to people had not been thoroughly assessed. The assessments themselves did not always clearly reflect what action staff should take in the event of that person becoming unwell or experiencing symptoms of known health conditions.

People’s care and support was not always planned in partnership with them and persons close to them. Staff received induction training. People told us they did not always feel supported by the staff, they felt rushed and anxious at times. People told us, staff did not always seek consent prior to supporting them and encourage people to make their own decisions. Where appropriate, staff supported people with nutritional and hydration needs, however care plans contained conflicting information for staff to follow.

People were not always supported to have maximum choice and control of their lives as they told us they were not involved in care reviews and when they had raised concerns these had not been addressed. Staff did not always support them in the least restrictive way possible and in their best interests; the provider had policies in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 01 March 2022).

Why we inspected

The inspection was prompted in part due to concerns received about missed and late calls, staff not staying the correct length of time, poor standards of care, not responding to complaints and infection control practices. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that the provider needs to make improvements to ensure the risk of harm to people is identified, and action taken to reduce these risks. Please see the safe, effective, caring, responsive and well-led key questions of this full report.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sentricare Birmingham on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to; Regulation 9 - Person centred care, Regulation 10 – Dignity and respect, Regulation 11 - Need for consent, Regulation 12 – Safe care and treatment, Regulation 13 – Safeguarding service users from abuse and improper treatment, Regulation 16 – Receiving and acting on complaints, Regulation 17 – Good governance, Regulation 18 – Staffing and Regulation 19 – Fit and proper persons employed, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

About the service

Sentricare Birmingham is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection the provider told us 76 people were using the service. The service was providing support to children, older and younger adults, people living with; dementia; learning disabilities; autism; mental health conditions; physical disabilities and sensory impairments.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People's experience of using this service and what we found

The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured of the choices and involvement of people who used the service in their care and support. There were several people being supported by the provider who had multiple needs including those with a learning disability and autism.

Right Support

We continued to be told people were not always supported to have maximum choice and control of their lives and they were not always involved in care reviews. Some people told us concerns they had raised these had not been addressed. Staff did not always support people in the least restrictive way possible and in their best interests.

We found guidance within some people’s care plans for staff members to follow when supporting autistic people or people with a learning disability who may express distress or frustration, had improved. Care plans and risk assessments in how to respond to such expressions did provide staff with information on how to respond, how to de-escalate for some people but not others.

Staff training and record keeping needed to be improved in relation to the Mental Capacity Act 2005 (MCA).

Right Care

People's care, treatment and support plans continued to not always reflect their range of needs or promote their wellbeing and enjoyment of life.

People who were known to express anxiety did not have proactive behaviour strategies documented in their care records. This meant they lacked detail on the specific actions staff should take to ensure practices were least restrictive to the person and reflective of a person's best interests.

Right Culture

Care was not always person centred and people were not empowered to influence their care and support.

Governance systems remained inadequate and not ensure people were kept safe and received high quality care and support in line with their personal needs.

At the last inspection the provider's oversight of the service had not identified some of the shortfalls we found during the inspection process as part of their audits and checks. At this inspection this continued.

Systems in place for managing complaints, safeguarding concerns, accidents, and incidents were not robust or effective. Not enough staff members were deployed by the provider to support people. The main complaint raised by people and their relatives continued to be the length and inconsistency of their care calls. Staff who attended people's homes remained inconsistent at times and for some staff their ability to communicate with people and their relatives was restricted due to language barriers.

People were supported by staff to take their medicines, however, guidance in place continued to not always be clear for staff to follow.

Staff did receive an induction when they started work but some people continued to tell us they felt staff members did not have appropriate skills and knowledge to support them how they wished.

Care plans and risk assessments continued to lack robust and clear guidance, with incorrect or conflicting information. Risk assessments continued to fail to direct staff on recognising symptoms of known health conditions.

People continued to tell us their care and support was not always planned in partnership with them, and persons close to them.

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 22 March 2023).

At this inspection we found the provider remained in breach of multiple regulations and they had either not implemented or maintained the improvements they said they had made.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has remained Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see safe, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sentricare Birmingham on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to; Regulation 9 - Person centred care, Regulation 10 – Dignity and respect, Regulation 11 - Need for consent, Regulation 12 – Safe care and treatment, Regulation 13 – Safeguarding service users from abuse and improper treatment, Regulation 16 – Receiving and acting on complaints, Regulation 17 – Good governance, Regulation 18 – Staffing and Regulation 19 – Fit and proper persons employed, Regulation 20 – Duty of candour at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service remains ‘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.

Sentricare Birmingham is a domiciliary care service which provides personal care to adults with a range of support needs in their own houses and flats. At the time of this inspection the service was supporting 240 people with personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Some people often experienced late care calls, which impacted on their lives and caused frustration. People’s care records did not clearly identify the level and nature of support they needed with their medicines. Two people we spoke with raised concerns about staff use of personal protective equipment (PPE). Some people raised concerns about staff’s attitude and approach to their work. Some people felt they did not have the access they needed to their care records.

Staff understood how to identify and report abuse. The risks associated with people’s care needs had been assessed and plans developed to manage these. Staff reported accidents and incidents involving people and management reviewed these to identify action needed to keep people safe.

Staff received an induction and training designed to give them the knowledge and skills they needed to work safely and effectively. People had support to prepare meals and drinks, where they needed this. People’s needs were assessed, and this information was used to develop effective care plans. Staff understood people’s right to make their own decisions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s care plans included information about their preferences and personal histories to help staff get to know them well and provide support the way they wanted. People’s cultural and religious needs were assessed and addressed. The provider took steps to protect people’s privacy.

People knew how to raise concerns and complaints and the provider had systems in place designed to ensure these were investigated and responded to. People and, where appropriate, their relatives were involved in the assessment of their needs. People’s communication needs were considered, and staff were provided with information to promote effective communication.

Staff felt supported by management and able to raise concerns or suggestions in relation to the service. Systems were in place to gather and review feedback from people and their relatives on their experiences of the care provided. The provider completed audits on key aspects of the service to identify areas for improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 21 September 2020 and this is the first inspection.

Why we inspected

This was a planned inspection as the service had not previously been rated.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.