Archived: Crest Healthcare Limited - 10 Oak Tree Lane

On 8 March 2018 we made an announced visit to the service and commenced a focused inspection to consider the provider’s compliance with the warning notice dated 27 July 2017, and to consider further information of concern received by us about the service. As a consequence of our findings from the first day, the inspection remit was expanded to a comprehensive inspection. A further announced visit to the service was made on 16 March 2018 to enable us to review further documents and speak with the registered manager.

The service is required to have and has a registered manager in place. 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.

At this inspection we found that the provider continued to be in breach of Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition we found other breaches of legal requirements. You can see what action we told the provider to take at the back of the full version of the report.

Crest Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger physically disabled adults. At the time of this inspection three people were receiving personal care from the service.

CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The provider failed to demonstrate clear oversight of the service and was not always aware of potential risks to people and care workers.

The provider’s systems and processes to assess and monitor the quality of the service were not effective in maintaining the required standards expected by us and other regulators. The provider had also failed to identify issues requiring immediate improvement.

People were not safe because some incidents of concern were not identified, or if they were reported, appropriate action was not taken.

People’s risk assessments, where available, did not always reflect the current risks for people and potentially placed them in danger of harm.

The provider did not ensure the care workers had sufficient support and effective training to undertake personal care tasks in compliance with applicable legislation and guidance.

The provider’s recruitment procedures were not consistently applied and did not adequately reduce the risk of employing unsuitable care workers.

People were supported to receive their medicines, however care workers had not been subject to regular competency checks and several mistakes or omissions were identified in the medication records.

People's support needs were recorded in care plans however there was a lack of evidence of reviews to ensure the care plans remained up to date.

People were able to make a choice about the food and drink made available to them to maintain their wellbeing, however where monitoring of the amount consumed was required this was not being done consistently.

The provider demonstrated knowledge and application of the legal requirements of the Mental Capacity Act 2005 and associated guidance and people were supported to have maximum choice and control of their lives. Care workers supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were assisted to be involved in activities in their local community and were supported to access health care professionals when required.

People were supported by caring and respectful care workers.

People and their family representatives knew how to complain or to express when they were unhappy about the service received.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At our last comprehensive inspection in August 2016 we found that the registered provider was in breach of regulations. This was because the service was not applying the principles of the Mental Capacity Act 2005 and people were not benefitting from a service that was well led, or operating effective governance systems. Following the inspection we met with the registered provider who submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook this announced inspection on 13 June 2017 to check that the provider had followed their own plans to meet the breaches of regulations and legal requirements. We found that the registered provider had addressed some of the concerns that we had identified at our last inspection and had met their action plan regarding one breach of regulation. The systems in place to ensure the quality and safety of the service were still not effective, and this inspection identified a new breach of regulation relating to recruitment of new staff. We are considering what further action to take.

There was a registered manager in post who was present throughout the inspection. 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.

Relatives we spoke with told us that people who received support were safe. The staff we spoke with were able to describe a range of actions they took to ensure people’s safety. Relatives told us that people who used the service benefitted from consistent and reliable staff. Staff understood their duty and responsibilities to report any allegation or suspicion of poor practice and abuse. There were sufficient numbers of staff working at the service. Where risks had been identified there were not always effective plans in place; however the staff knowledge of people’s needs ensured people continued to receive safe care.

People using the service required the support of staff to administer their medicines. Records we looked at did not always show that the medicines had been available to administer or that they had been given as prescribed. The registered managers own checks had failed to identify these issues and action had not been taken to provide assurance that medicines were being administered as prescribed, to meet people’s healthcare needs.

People were supported by staff who were able to undertake their role. Staff received some training from the registered manager, and further training and support from the family members of the people they supported. New staff were supported to complete an induction programme. The registered manager’s recruitment records didn’t show that all the required checks had been undertaken, to ensure staff were suitable to provide personal care. Staff understood the principles of the Mental Capacity Act (MCA) and respected people’s decisions and gained consent before they provided personal care and support. Staff were aware of people’s needs in relation to nutrition and hydration

Relatives shared examples of how their family member was supported by staff who were compassionate and caring. Staff told us that they listened to people and encouraged them to make decisions about how their care was provided. Staff shared examples of how they treated people with dignity and respect and maintained their privacy when personal care was being provided.

People received care and support that reflected their expressed needs and individual preferences. Care plans were personal to each person. Relatives felt able to complain and records showed that concerns identified would be responded to in a timely manner.

Relatives were satisfied with the service their family member received however the service was not well led. The systems in place to assure the safety, quality and consistency of the service were not adequate. Checks and audits had not been effective at identifying matters that needed attention. Despite this being brought to the attention of the registered manager at our last inspection; they had not taken timely or adequate action to improve this aspect of the service.

You can see what action we have required the provider to take at the back of this report.

There is a registered manager in place who was present throughout the inspection. 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.

Whilst relatives were happy with the management of the service we found that systems in place to monitor the quality and safety of the service were not always robust. The provider had not identified where there was a need for improvement to respond to risks and meeting changing needs of people. You can see what action we told the provider to take at the back of the full version of the report.

The Mental Capacity Act (2005) (MCA) applied to some people using this service. Staff had not received training related to this legislation and through discussions with staff it was apparent that they were not working within the principles of the MCA and people’s rights were not protected.

Where people had been assessed as lacking mental capacity staff were unclear about what decisions the person was unable to make. You can see what action we told the provider to take at the back of the full version of this report.

Relatives told us that their family member was safe receiving support from the service. People were supported by staff that were aware of how to recognise and report concerns relating to people’s safety.

Staff had received training in medicines administration. We found there was some improvement needed in the management of medicines given on an ‘as required basis’.

Individual risks to people had been identified but action had not always been taken to reduce these risks.

Staff told us they felt supported in their role and there were systems in place for staff to feedback concerns. Training was provided to staff although updates in training had not occurred for some time and staff had not received training on some people’s specific health conditions.

People received support from consistent staff who had got to know them well. People and their relatives had contributed to planning care that met their needs. Some care plans lacked detail of people’s preferences.

Staff were able to describe systems in place that would enable them to receive updates on any changes in people’s care needs. Relatives told us that the service kept them informed of any changes in their family member’s needs.

People and their relatives had not always been given the opportunity to review care to ensure it still met their needs.

There were systems in place for people and their relatives to raise concerns and complaints. Relatives felt confident in raising any concerns they had with the service.

Following the inspection the registered manager provided us with updates about improvements they had made and reassured us that the issues identified during the inspection would be addressed.

During our visit we spoke with the manager and deputy manager. Following our visit, we spoke with three people who used the service and with the relatives of four people. We also spoke with three members of staff.

People we spoke were happy with the care they received. All of them told us they felt safe when they were supported with their care needs. They told us that they had regular care staff supporting them. One person told us, 'I've used them for a number of years, they're very good.' A relative told us, 'I would recommend them to anyone.'

We found that people's needs were assessed and care was planned and delivered in line with their individual care plan. Care plans were regularly reviewed for any changes in a person's needs.

The provider's recruitment systems did not ensure that all appropriate information was in place before employing staff to provide personal care to people.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us that staff were responsive and adjusted their hours and practices as required in order to meet people's changing needs.

People experienced care, treatment and support that met their needs and protected their rights. One professional described the staff as 'very conscientious' and told us, 'they show respect and dignity towards X...they will regularly change shifts to help support my client'.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff were trained in recognising the possible signs of abuse and how to report this.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. In addition to their basic training, staff were trained to provide the specific assistance which some people needed.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. This included questionnaires and checks by the manager.