Background to this inspection
Updated
23 October 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by an inspection manager and an inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in [their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
Inspection activity started on 19 November 2020 and ended on 23 November 2020. We visited the office location on 19 November 2020.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with the administrator. We took photographs of all physical evidence available to us, to limit time on site on light of COVID-19. We asked the provider for an additional list of missing documentation and gave them 96 hours to submit this to us.
After the inspection
We reviewed the evidence collated during the site visit. We reviewed additional submitted documentation such as risk assessments, training records and staff appraisal records. The provider failed to provide all the information we required by the deadline set. We gave them another opportunity to submit the documentation requested at the inspection and they partially submitted the requested information. We spoke with one relative, as both people who use the service were unable to tell us of their experiences. We also spoke with five staff.
Updated
23 October 2021
About the service
Caxton Recruiting Services Ltd is a domiciliary care agency providing personal and nursing care to two people aged 65 and over at the time of the inspection.
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 repeatedly failed to ensure there was sufficient oversight and management of the service. The registered manager failed to offer adequate support to people, their relatives and staff. Incidents, accidents, complaints and safeguarding concerns were not appropriately responded to. There were no governance systems across the service and the provider did not understand their responsibilities or regulatory requirements.
Potential risks to people were not always suitably mitigated. Medicines management processes could have been clearer. Not all staff had received up to date infection control training. There was concerns that people were at potential risk of avoidable harm.
Staff were not supported to carry out their roles through satisfactory supervision, appraisal and training. We were not assured that provider did all that was possible to ensure staff were equipped to carry out their roles.
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.
Care records did reflect people’s preferences, including their nutritional needs and support required from other healthcare professionals. There were enough staff to attend people's visit requirements.
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 Inadequate (published 11 July 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caxton Recruiting Services Ltd on our website at www.cqc.org.uk.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to good governance, staffing, safeguarding, safe care and treatment and complaints during this inspection.
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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
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.