Archived: Cancare Home Services Limited

Cancare Home Services was established in 1995 and is a very small service. The main part of the service is a domestic service, which is not part of the registration. Cancare provide short visits to older people who require personal care. The service provides care and support to people in Canterbury, Herne Bay and surrounding areas. Since our comprehensive inspection in January 2017 the number of people receiving a service had reduced to six and the five members of the care staff team were unchanged.

We carried out a comprehensive inspection of this service on 17 and 18 January 2017. Eight breaches of legal requirements were found relating to medicine management, care planning, assessment and managing risks associated with people’s care and support, a lack of understanding and following the principles of the Mental Capacity Act 2005, having effective systems for complaints, safeguarding people from abuse and ensuring compliance with the regulations and lack of proper procedures relating to recruitment, training and supervision of staff.

After the comprehensive inspection the provider wrote to us on 22 February 2017 to advise what action they had taken since the inspection in order to keep people safe and meet the regulations.

We undertook this focused inspection to check those actions and obtain a current view of the breaches.. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cancare Home Services Limited on our website at www.cqc.org.uk

The service did not have a registered manager, which is a legal requirement. 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. Since our comprehensive inspection in January an application to register a manager had been received and was being processed by the Commission.

Each person had their needs assessed and a care plan in place. However needs assessments contain only basic information and care plans lacked the detail about people wishes, preferences or what they could do independently.

Each person had risk assessments in place. However not all risks associated with people’s care and support had been assessed and actions to keep people safe had not been recorded.

There remained a lack of safeguarding procedures and the provider and staff had not received up to date training to help them understand and recognise abuse and neglect and keep people safe.

People were not protected by robust recruitment procedures and staff had not received appropriate training, support or appraisals to ensure they carried out their role effectively.

People had received a copy of the complaints procedure, but this lacked key information. For example, a timescale when the provider would respond and what action people could take if they were not satisfied with how their complaint had been handled.

People had been contacted following the last inspection by the provider to advise of the inspection findings and gather their feedback about the service they received.

Since the last inspection the provider had stopped all medicine administration including the application of creams and therefore the one restriction in place regarding medicines had been removed.

There remained an open and positive atmosphere in the office and the provider was committed to ensuring people received good care and support. However they continued to lack a full understanding of the regulations and compliance. Copies of care plans and risk assessments were now available for inspection within the office.

People’s need were met by sufficient numbers of staff.

Cancare Home Services was established in 1995 and is a very small service. The main part of the service is a domestic service, which is not part of the registration. Cancare provide short visits to older people and at the time of the inspection it provided a personal care service to nine people. The service provided care and support to people in Canterbury, Herne Bay and surrounding areas.

The service did not have a registered manager, which is a legal requirement. 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.

The provider told us staff did not administer medicines, but only applied creams. Staff were administering medicines and creams and there was a lack of proper procedures and record keeping in place to ensure risks associated with handling medicines were reduced.

Risks associated with people’s care and support had not always been assessed and actions to keep people safe had not been recorded.

People felt safe using the service and when staff were in their homes. However there was lack of safeguarding procedures and staff had not received up to date training to help them recognise abuse and neglect and keep people safe.

People were not protected by robust recruitment procedures and staff had not received appropriate training, support or appraisals to ensure they carried out their role effectively.

People told us their consent was gained at each visit and they were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection; one person had made Lasting Power of Attorney arrangements for their finances. There was no evidence of any Do Not Attempt Resuscitation (DNAR) in place. The provider told us people were able to make their own decisions, although some people chose to be supported by family members. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. One person was subject to a restriction, but their capacity to make such a decision had not been assessed and there were no records of the decision making process that had taken place.

Some people had not had their needs assessed or been involved in drawing up a care plan that reflected their preferred routine and their wishes. Care plans lacked detail about people wishes, preferences. People told us their independence was encouraged wherever possible, but this was not supported by the care plan.

The provider knew each person that used the service personally and had contact with them. People contacted the provider when there was a concern and they felt confident they would resolve this. However there was no formal complaints procedure or systems for people to give feedback about the service.

There was a lack of records to support the management of the service and as a consequence there were no audits or systems in place to monitor that the service ran efficiently. The provider had not identified the shortfalls highlighted during this inspection and did not have any action plan in place to address the shortfalls.

People felt most staff were caring and respected their privacy and dignity. However one person gave examples where they felt this had not been the case, which was at the time of the inspection being investigated.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. People were supported to maintained good health. Staff supported people with their meals and drinks appropriately.

There was an open and positive atmosphere in the office and the provider was committed to ensuring people received good care and support.

People had their needs met by sufficient numbers of staff. All of people’s visits were usually allocated permanently to staff schedules and these were only changed when staff were on leave. People received a service from a small team of regular staff.

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 12months. 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.

The assessment process was robust so that the agency knew about a person's range of needs before they offered a service. The provider always met with people in their homes so that any potential risks could be identified and assessed. Care plans were detailed giving staff the guidance they needed to ensure that they met people's needs.

People said that the service was reliable. People said staff were 'kind and understanding.' There were systems in place to check the quality of the service so that people continued to receive a good quality consistent service.

One of above the named managers Miroslav Pekarcik is no-longer the registered manager at Cancare Home Services. The registered manager is John Haigh. The company will be deregistering this person.