Background to this inspection
Updated
7 September 2023
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 Health and Social Care Act 2008.
Inspection team
This inspection was carried out by 2 inspectors and 1 medicines inspector. The medicines inspector supported this inspection remotely.
Service and service type
This service is a domiciliary care agency. It provides personal care to children living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 14 March 2023 and ended on 21 March 2023. We visited the location’s office on 14 March 2023. We held a meeting with the registered manager and branch manager via remote technology on 23 March 2023.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. Following our inspection, we sought feedback from the local authority and professionals who work with the service.
We used information gathered as part of monitoring activity that took place on 6 March 2023 to help plan the inspection and inform our judgements.
During the inspection
Due to the needs of the children they were unable to talk to us. We therefore spoke with 5 of the children’s relatives. We spoke with the branch manager and 5 staff. We also received 2 responses from staff following our email questionnaires we sent out to all staff.
We reviewed 4 children’s care records and associated information. We reviewed 7 staff recruitment and induction records and a variety of other admin documents and policies.
Updated
7 September 2023
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Care Solutions Recruitment Agency Ltd – Manchester is a domiciliary care agency providing care predominately to children in the community or their own homes. The service supports children with various physical needs as well as autistic children and children with a learning disability. At the time of the inspection the service was supporting 4 children out of the 11 they supported with personal care.
People’s experience of using this service and what we found
Right Support:
Risks in relation to moving and handling, medicines, infection prevention and control and complex care had not been explored. Risk assessments were often not completed, which meant there was no guidance for staff about how to support people safely in these areas.
Right Care:
The service did not have enough suitably trained and skilled staff to meet people’s needs and keep people safe. Staff received training on safeguarding adults and abuse awareness, but no additional training was provided on safeguarding children, this was concerning given the service predominantly supported children.
Care was not always person centred and co-ordinated well. Information in the children’s care plans did not reflect their full range of needs or promote their well-being and enjoyment of life. Guidance for staff was sometimes missing and did not therefore enable personalised and accurate support.
Right Culture:
There was not always a person-centred culture at the service. Systems and processes had not been followed for quality assurance and to improve the service people received. The registered manager did not have oversight of the service and did not conduct any audits and analysis of quality themselves. This meant the quality-of-care people received was not sufficiently monitored and areas of concern not always identified.
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 19 April 2022, and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
Enforcement and Recommendations
We have identified breaches in relation to medicines, managing risks, safe care, unsafe recruitment, staff training, and quality assurance processes at this inspection.
We have made a recommendation about the service approach to the Mental Capacity Act (MCA).
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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures:
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.