Archived: Caxton Recruiting Services Ltd

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.

Caxton Recruiting Services Ltd is a domiciliary care agency providing personal care to 3 older people at the time of inspection.

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

There were continued failings across the management and oversight of the service. The provider had not made improvements following our last inspection, and we identified further areas of inadequate practice.

Risks to people were not suitably assessed or addressed. Staff recruitment practices were not always robust. Potential safeguarding concerns were not reported in a timely manner.

Staff did not receive sufficient training and were not always able to understand elements of their role. People were not always suitably supported with their nutritional needs.

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.

People’s care files did not identify whether they had end if life wishes. Concerns and complaints were not always promptly responded to. Care records required further personalisation to ensure people were supported in the ways they preferred.

People and relatives did feel they were cared for well. Staff received an annual appraisal of their needs and regular spot checks.

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 on 22 May 2019 (report published 25 July 2019). 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 was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed, safeguarding, need for consent, receiving and acting on complaints and good governance and record keeping at 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 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 work with the 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.

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:

Caxton Recruiting Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of inspection three people were receiving care from the service.

Not everyone using this service receives regulated activity; 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.

People’s experience of using this service:

The service was not well-led, with concerns identified about the day to day running of the service. Quality assurance systems were not in place to review the quality of the service, and the registered manager had therefore not identified issues such as those we found at inspection. Sufficient quality assurance systems were not in place to ensure that steps were taken to drive improvement. The registered manager had not taken suitable action to make improvements to areas we had identified at our last inspection.

Staff were not always clear on how to recognise and report potential safeguarding incidents. People’s risk assessments were not updated in a timely manner, to reflect current need. Recruitment processes were not always robust in reflecting that staff had suitable experience to work with people. There was no evidence of incidents and accidents being investigated as they occurred.

Staff training did not always provide ample time for staff to undertake indepth knowledge for them to carry out their roles. Staff were not always clear on how the Mental Capacity Act (MCA) applied to their roles.

People’s care plans were not always regularly updated. Nor did they always indicate people’s end of life wishes. Complaints records were not routinely kept.

Relatives did feel that their family members were well cared, and staff were able to demonstrate they knew people’s needs. People were supported with their nutritional needs and referred to healthcare professionals as necessary.

Rating at last inspection:

At our last inspection of 17 April 2018 (published 30 May 2018) we rated the service ‘Requires Improvement’.

Why we inspected:

All services rated "requires improvement" are re-inspected within one year of our prior inspection.

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

At this inspection we found a continued breach of the regulations in relation to good governance. We also identified an additional breach in relation to staffing. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

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

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

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, presenting with dementia, mental and/or physical disabilities.

Not everyone using Caxton Recruiting Services receives regulated activity; 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.

At the time of this inspection only one person was receiving regulate activity. The person using the service received care over 24 hours seven days a week.

A registered manager was 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 have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We identified a breach of regulations during the inspection. This was in regards to good governance. You can see the action we have told the provider to take with regard to this breach at the back of the full version of this report.

The service was not as well-led as it could have been. Records in relation to staff supervision, appraisals and policies were not accessible or in place. The registered manager had not identified that the person using the service required a care plan review. The registered manager did not keep records of all of the quality assurance checks they completed.

Some improvement was required to ensure that recruitment processes were safe and that staff provided full employment histories and appropriate references. We raised this with the registered manager who told us they would take action to ensure these issues were remedied.

There were sufficient numbers of staff to carry out the duties required. Risk assessments were in place to enable staff to understand how best to support people safely. Medicines administration was accurately recorded in line with the person’s needs. Staff were aware of the signs to look out for in protecting people from the risk of abuse.

Staff were supported and encouraged to undertake qualifications relevant to their role, as well as appropriate training. Staff told us that they received regular support from management through supervision and appraisals. The person using the service was supported to maintain a healthy diet and access healthcare professionals when they needed to. The registered manager was aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA).

The person was cared for by staff that knew them well. Staff supported the person to make decisions for themselves and respected their privacy and dignity.

Care plans were based on a thorough pre-assessment and reflected people’s preferences in how they liked to be cared for. The provider had a complaints policy in place, and had not received any complaints since our last inspection.

Staff were positive about the support they received from management. The registered manager was clear in their role and responsibilities in notifying the CQC of important incidents.

Caxton Recruitment Services is a domiciliary care service that provides personal care as well as general support to people in their own homes such as meal preparation, prompting medicines, laundry and general household support. The registered manager told us the service provided personal care to one person at the time of this inspection but that this was the start of a new contract the agency had recently gained. They expected to take on more work in the near future. The person concerned received 24 hour care each day of the week from this agency.

At the time of the inspection, there was a registered manager. 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.

We were told by those people we spoke with this was a good, safe service and said they were quite happy with it. They told us that the staff who supported them knew them and how to provide the care and support to meet their needs.

Appropriate risk assessments were in place that helped protect the person and staff in the delivery of care and support.

The person and their relatives told us there were sufficient numbers of staff who helped support them in the way they needed to be cared for. We saw the service had sufficient staff available to support people. Safe systems were used when new staff were recruited to ensure they were suitable to work in people's homes.

We saw evidence that the person received their medicines safely and appropriately. People told us they were treated with kindness and respect and was included in all decisions about their care.

We found that the provider involved the person and their relatives in planning their care and their views were sought when decisions needed to be made about how they were cared for. The service involved them in discussions to help keep them safe and promote their wellbeing. Staff treated them with respect and dignity.

The person and their relatives indicated that they felt that the service responded to their needs and individual preferences. Staff supported the person according to their personalised care plans. Care plans were reviewed annually or earlier if the person’s needs changed.

We saw there was an appropriate complaints policy in place that people were aware of. People told us that the provider encouraged people to raise any concerns they had and responded to them positively and in a timely manner.

There was a clear management structure to ensure the service was running in a way that was efficient and effective in supporting staff and to ensure the quality of the service offered to people.

The provider had arrangements to deal with complaints and concerns that might be raised by people or their relatives. The registered manager asked people for their views about the care they received and acted in response to their feedback.

We received positive feedback about the management of the service. The registered manager and the staff were approachable and fully engaged with providing good quality care for people who used the service. The provider had systems in place to continually monitor the quality of the service and there were arrangements for people to be asked for their opinions via surveys. Action plans were developed where required to address areas for improvements.

People said they were told by the office when the care worker might be late and they said they knew how to make a complaint if they needed to do so. One person said, 'I'd ring the office to make a complaint and speak to the manager'.

People said they were told by the office when the care worker might be late and they said they knew how to make a complaint if they needed to do so.

One person said, 'First of all I'd ring the office to make a complaint and I'd speak to the manager, after that if I wasn't happy I'd speak to the council'.