Archived: Civicare Midlands Ltd

Civicare Midlands Ltd is a domiciliary care agency that is registered to provide personal care. At the time of the inspection the service was providing support to 42 people living in their own homes. Most of these were older people or people with a disability. There was 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.

People were not protected from potential abuse as the provider did not ensure both they, the staff and management team were managing safeguarding concerns safely. People were not protected from harm due to unsafe recruitment practices. People were supported by sufficient numbers of staff and we found improvements had been made to the times at which people received their care visits. People were happy with the support they received with their medicines. However, some improvements were still needed in the safe management of medicines.

People’s rights were not always upheld by the effective application of the Mental Capacity Act 2005. People told us the skills of the staff team had improved, however, we identified further areas of improvement were needed. People were happy with the support they received with their food and drink and most people’s day to day health was maintained.

People told us care staff were mostly kind and caring however this was not always consistent across the whole staff team. People were supported to make choices about their care. However care staff did not always understand how to make choices in people’s best interests where they lacked capacity to make these decisions. People were cared for in a dignified way and their independence was promoted.

Most people told us they received care that met their needs and preferences. The provider had not always identified where some people still did not receive care that met their needs. People told us the provider’s response to complaints had improved but further improvement was still required.

People were cared for by a staff team who felt supported by the management team. However, people were not protected by a quality assurance system that identified the areas of improvement needed within the service. We found significant failings in the provider’s ability to understand and recognise when care provided did not meet the required standards. The provider did not have an understanding of their legal requirements or the expected standards of providing consistently good, safe care to everyone using the service.

We found the provider was not meeting the regulations around safeguarding people from abuse, safe recruitment of care staff, consent to care, managing complaints, effective management of the service and submitted statutory notifications to CQC. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection completed in May 2016, we rated the provider as ‘inadequate’ and the service was placed into special measures. The overall rating for this service at this inspection is ‘Inadequate’ and the service therefore will remain 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, 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.

Civicare Midlands Ltd is a domiciliary care agency that is registered to provide personal care. At the time of the inspection the service was providing support to 53 older people living in their own homes. There was 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.

People were not always sufficiently protected from potential harm. Risks to people were not always identified, recorded and known to staff. Therefore risks were not always effectively managed and reduced in order to keep people safe. The provider did not have sufficient systems in place to be certain people received their medicines as prescribed.

People were not always protected from potential harm due to unsafe recruitment practices. Sufficient pre-employment checks were not always being completed before staff members started work. Staff members had a basic knowledge of how to keep people safe from potential abuse.

People were not always supported by staff who consistently had the sufficient knowledge and skills to keep them safe. Not all staff members had the knowledge and skills to implement people’s plans of care safely.

People were asked for their consent to their care. People were supported to eat and drink sufficient quantities. People were supported to access healthcare professionals when required.

People were not consistently supported in a caring, dignified and respectful way. While most care staff were kind and caring in their approach, people felt there were several staff members who lacked the same approach. People’s were given choices in their day to day care and support. People were supported to remain independent.

People’s care did not always reflect their needs and preferences, in particular, the times at which they received their care visits. People’s care plans did not always accurately reflect their needs and preferences. People’s complaints were not always investigated and responded to appropriately.

People were not supported by a management team who were able to recognise the areas of improvement required within the service and take steps to make improvements. The provider had not developed effective quality assurance systems to ensure that improvements were made where required. People and staff did not always feel confident to raise concerns with the service without fear of repercussions. The culture of the service was not open and transparent.

We found the provider was not meeting all of the regulations required by law. You can see what action we told the provider to take at the back of the full version of the report.

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, 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.

Abacuscare West Midlands provides a domiciliary care service which is regulated by CQC and also operates a recruitment agency. The recruitment agency is not regulated by the CQC. The recruitment agency provides care staff to residential and nursing homes when required. We were told that some staff work in both the domiciliary care service and in residential and nursing homes when required.

We were told that for all staff supplied to a home, Abacuscare West Midlands sent copies of staff profiles and evidence of disclosure and barring (DBS) clearances to the manager of the home. This provided evidence that the staff had been checked to work with vulnerable people. It also showed that the staff were of good character and trained appropriately to provide care in the home.

We were informed that recently this information had not been supplied and could put people who used care services at risk. We checked three staff records and the references received for each individual. We looked at the DBS checks for each staff member who worked in the domiciliary care service. We found that the service had recognised some weaknesses in their recruitment procedures and had taken action to address these.

The registered manager told us that the service had changed its name to Civicare. The registered manager told us that there were no other changes to the service and that a notification had been sent to us to confirm this change. Until the required change is made the service will still be referred to as Abacuscare.

During the inspection we spoke with the registered manager. We telephoned and spoke with five care staff, two people who used the service and six relatives after our visit to the office.

We saw that there were arrangements in place to gain people's consent to the care and support they required.

People told us that they or their relative received the care they wanted and needed. Records of the care however did not always confirm that people had the care they needed. We also found that plans of care required additional information to provide assurance that people and staff would be aware of all people's care needs. One person who used the service told us: "The care I receive is ok". One relative said: "I am happy with the care my mum gets now". Another relative said: "I would definitely recommend Abacuscare we have been very lucky to have them".

There were systems in place to protect people from the risk of infection.

We found that improvements were needed to ensure that staff had the required skills and knowledge to provide safe and appropriate care and support.

Improvements were needed to enable the provider to effectively assess and monitor the quality of the service provided to protect people against the risk of receiving inappropriate or unsafe care.

We also found that records of the care provided were not always accurate or complete.

People told us, "Staff are very polite and they know me well". They told us that staff were respectful and provided assistance when they needed it. People told us that they had an agreed number of visits but if they wanted to stay in bed, or stay up later than planned, care staff would come back later to assist them.

We found that support plans and risk assessments were kept under review. This meant that people received the care they needed.

We saw that the management and administration of people's medicines was undertaken safely which meant that people received their medicines as prescribed.

We saw that the service had a robust safeguarding system in place, including regular training for staff. This meant that people using the service were appropriately protected.

We saw that the service had a quality assurance system in place ensuring that people received safe and appropriate care that met their needs.