Background to this inspection
Updated
21 July 2022
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
The inspection was completed by five inspectors, one assistant inspector and an Expert by Experience. Calls to people and their relatives were carried out by an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. Two inspectors visited the provider's offices and two inspectors, and an assistant inspector gathered feedback from staff via the telephone.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of the inspection there were 68 people using the service.
Not everyone who used the service received personal care. 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.
The service did not have a manager registered with the Care Quality Commission. This means the Provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the manager 24 hours' notice of our first inspection visit. This was because we needed to be sure that they would be in the office to support the inspection. Our second inspection visit was unannounced. Inspection activity started on 27 October 2021 and ended on 05 November 2021. We visited the office location on 27 October 2021 and 04 November 2021.
What we did before the inspection
We reviewed the information we had received about the service since our last 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. We also gathered feedback from the local authority who fund the care provided. We used all of this information to plan our inspection.
During the inspection
We spoke with eight people who used the service and six relatives. We spoke with 13 members of staff, including care workers, community assessors, the manager, the head of quality and compliance and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records, including seven people’s care records and the recruitment records for three staff. We looked at records in relation to staff training, safeguarding, complaints and the management of the service including quality audits and checks and a range of the provider’s policies and procedures.
After the inspection
We spoke with the nominated individual and received information from the management team to validate the evidence we found. We also shared our inspection findings with the local authority.
Updated
21 July 2022
About the service
InTouch Home Care is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 68 people with personal care at the time of our inspection.
People’s experience of using this service and what we found
The provider had not learned lessons since our last inspection and their governance systems to monitor the service remained inadequate. In addition, the quality and safety of the service had deteriorated further over the last 14 months which demonstrated the provider was unable to make and sustain improvements. Information we received from the management team following our inspection visits informed us action was being taken to make improvements.
The provider’s systems to keep people safe were ineffective. We found action had not always been taken to protect people from the risk of ongoing abuse. The provider told us they planned to strengthen their safeguarding systems to improve safety. People did not always know their care workers which made them feel unsafe. Staff had completed safeguarding training and described the types of abuse people could experience.
The information staff needed to help them manage some risks and provide safe care was not always in place. Auditing processes had not identified when risks associated with people’s care had not been assessed. Action was taken in response to our feedback to drive forward improvement in this area.
The management of medicines was not safe, and the unsafe administration of medicines had placed people at risk of significant harm. Action had not always been taken to mitigate known medicine management associated risks and prevent reoccurrence. The provider was not working in line with their medicines policy or national medicines guidance and their audits of medicines were not effective. Some action was taken following our inspection to improve medicines safety. Staff had completed COVID-19 testing in line with national guidance, but individual risks to people and staff who were at increased risk from Coronavirus had not been assessed.
Staff were recruited safely, and the provider was open and honest about their challenges in relation to the recruitment and retention of staff. Prior to our inspection they had been unable to provide safe care to people due to low staffing levels. At the time of our inspection people had received their planned care, but people and their relatives were dissatisfied because their care was not always provided on time. In addition, care was not always provided by staff people knew and trusted.
An open culture was not embedded at the service. Complaints continued not been managed in accordance with the provider's policy and people and their relatives did not always feel well treated and listened to. Staff provided mixed feedback when we asked them if they felt valued and listened to by their managers. The management team were open and honest during the inspection and recognised good outcomes for people had not always been achieved.
Staff continued not to receive all of the training they needed to carry out their roles and meet people’s specific needs. Feedback gathered demonstrated how the lack of training impacted negatively on people’s lives. Checks to ensure staff were competent and skilled to carry out their roles did not always take place.
Responsive action took place following our inspection to start to address this. Staff told us the induction they had completed when they had started work at the service had helped then understand how to support people.
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 dietary requirements and preferences were documented and overall, positive feedback was provided about the support people received to eat and drink. When required, referrals had been made to health professionals such as district nurses to access the support people needed to remain healthy and well.
Whilst assessments of people's needs had been completed before they started using the service, care and support was not personalised. Some people felt respected whilst others did not. Staff told us how they supported people to remain independent, but people’s dignity was not always maintained.
More information needed to be added to some care records to help staff provide care in line with people’s wishes. Care records contained some information to help staff understand how people preferred to communicate and information about the service was available to people in a variety of formats including large text.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The last rating for this service was requires improvement (published 19 October 2020). 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 and was also prompted due to the provider informing us they could not provide safe care to people.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. 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.
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 providing safe care and treatment, staffing, consent, dignity and respect, person centred care, complaints and governance 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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will work alongside the provider and local authority to monitor actions taken to address the concerns we identified.
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.