Archived: Cestrian Care

Updated 4 May 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 25, 28 and 29 January 2016 and 9th February 2016 and the first day was unannounced.

The inspection team consisted of an adult social care inspector and an inspection manager.

Before the inspection, we reviewed the information we held about the service including, notifications, complaints and concerns raised directly with us.

We visited the office at The Enterprise Centre on 25 January and 9 February and reviewed information in regards to the management of the service. This included twelve staff files, training and supervision records, quality audits and policies and procedures. We also reviewed care plan documentation and records relating to four people who used the service.

Between the 28 and 30 January we spoke to nine people who used the service and five relatives. We also spoke to six people who worked or had worked for the service.

We contacted the local authority safeguarding and contracts team as they had been involved in the investigation and review of this service following our last inspection in July 2015. They had substantiated our concerns.

Updated 4 May 2016

We started an unannounced inspection on the 25 January 2016 and visited the premises at The Enterprise Centre, 14 Parade, and Chester. CH1 5NH. As part of the inspection we spoke to people who used the service and staff on 28 and 29 January 2016. We returned announced on the 9 February to provide feedback and gather some additional information.

Cestrian Care is a domiciliary care agency which provides support and personal care to people in their own homes. The agency is based in Chester and provides support and care within the surrounding areas and Ellesmere Port. Cestrian Care is registered to provide a service from both 68 Norris Road, Blacon. Chester. Cheshire CH1 5DZ and Unit 2 Chester West Business Park, Minerva Avenue, Chester. CH1 4QL.

They currently provide and manage their service from The Enterprise Centre, 14 Parade, and Chester. CH1 5NH but this location is not yet registered with the CQC.

This is the location that we visited for the purpose of our inspection.

We carried out an unannounced comprehensive inspection of this service on 16 July 2015 and found breaches of legal requirements. The overall rating for this provider was ‘Inadequate’. This meant that it was placed into ‘Special measures’ by CQC. Services placed in special measures are inspected again within six months and the service kept under review.

The purpose of this inspection was to check if the registered provider now met legal requirements and to ensure that people who receive the service are provided with safe and effective care. However, we found that the registered provider was still not meeting legal requirements and we identified a number of ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. This inspection found that there was not enough improvement to take the registered provider out of special measures. CQC is now considering the action to be taken.

People who used the service had mixed views about the care that they received. Some people said that the staff were polite and caring towards them. They told us staff were quite reliable and that there had been only a few occasions when staff had arrived late. Other people said that the staff did not treat them with dignity and respect and that they felt rushed.

An assessment of people’s needs had been carried out by the registered provider prior to people using the service but these were not kept up to date following any changes in people’s physical or mental health needs. The current systems in place failed to demonstrate how a person needed their care delivering. This put people at risk from not receiving the care and support they required.

People’s medicines were not managed appropriately and they were at risk from not receiving their medicines when they should.

The processes that the registered provider had in place for recruiting staff were unsafe because they did not ensure that staff were suitably skilled, had the right experience or were of good character.

Training provided to staff was inconsistent and it was delivered by someone who did not have up to date knowledge and was not qualified to provide such training. Staff supervisions were not regularly carried out, therefore, staff had not all been assessed as being confident and competent to carry out their role.

Not everyone felt able to complain or have the confidence that concerns would be addressed. Informal complaints were not logged. People’s views of the service were not always sought or formally recorded and no action was taken when issues were raised.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005) and to report on what we find. Staff gained consent from people prior to providing care or services, however where people lacked capacity we saw that arrangements were not in place for staff to act in the person’s best interests. Staff lacked knowledge about the Mental Capacity Act (MCA) 2005).

Quality assurance checks on care plans and care delivery were ineffective because they failed to identify areas for improvement. For example, the registered provider and manager had failed to identify and address areas that required improvement in relation to medicines management, staff recruitment, records and risks to people.

The overall rating for this service is ‘Inadequate’ and the service remains 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.