Archived: Care & Connect

Care & Connect is a domiciliary care agency, providing personal care and support to people living in their own homes. The service operates from an office based in St Helens, close to the town centre. There were 41 people using the service at the time of our inspection.

The service has a registered manager who is also the registered provider. They were registered with CQC in October 2016. 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.

We carried out an unannounced comprehensive inspection of this service in April 2017 and found that the registered provider was not meeting all the requirements of the Health and Social Care Act 2008 and associated Regulations. We asked the registered provider to take action to make improvements to the recruitment of staff, records, and assessing, monitoring and improving the quality and safety of the service. We received assurances from the registered provider that all actions had been completed. However at this inspection we found that the registered provider had not met these legal requirements and we found further breaches of the Health and Social Care Act 2008.

Prior to this inspection we received concerns from members of the public about staff recruitment, care and welfare of people and the leadership of the service. We looked at those concerns as part of this inspection.

The required improvements had not been made to ensure the safe recruitment of staff. Recruitment of new staff was not always safe and thorough. The required checks were not always obtained for staff employed. There were no recruitment records for one member of staff including evidence of a check on their criminal background. References checks obtained for some staff employed did not correspond with their previous employment history and gaps in employment history for staff employed were not explored. The lack of robust recruitment checks put people at risk of receiving care and support from unsuitable staff.

The timeliness of visits to people’s homes was poor. We found multiple examples were visits to people’s homes were late; some were late in excess of two hours. This resulted in people not receiving the care and attention they needed at the right times putting their health and safety at risk.

Risks which had the potential to cause people harm had not been assessed and mitigated. One person had complex needs, however no risk assessments had taken place to determine the level of risk for the person and others, and how they were to be managed to keep the person safe.

Accidents and incidents had occurred however they were not appropriately reported and recorded. In addition no action had been taken to analyse the incidents as a way of looking at ways of reducing the risk of further occurrences. This exposed people to the risk of harm.

The management of medication was unsafe putting people at risk of harm. There were no protocols in place to guide and instruct staff on the use of ‘as required’ medication (PRN), this was despite the registered provider’s medication booklets stating that a specific plan for administration of PRN medication must be recorded. Some people did not receive their prescribed medication because the stock had run out and because of the poor timeliness of visits. One person did not receive pain relief because the medication was unavailable and another person received pain relief over two hours late due to poor timeliness of visits.

People did not have their needs met by staff who had received the right training and support for their role. Upon appointment staff completed induction training based on The Care Certificate, a nationally recognised qualification for health and social care workers. However staff were not provided with training specific to the needs of people. Some people required end of life care and catheter care however staff had not received any training around how to deliver this care. No checks had been carried out to check on staff competence in relation to practical tasks they carried out such as moving and handling and administration of medication.

Staff felt unsupported by the registered manager/provider. They told us that the registered manager/provider was difficult to contact. Staff supervisions had not taken place to assess and monitor their performance and training and development needs. This was despite the registered provider’s policy stating that staff would receive supervision within the first three months of employment and on a regular basis thereafter.

People were not always treated with respect. People were left waiting for long periods of time for staff to attend their homes and on many occasions they were not contacted to be notified of the late visit. This unsettled people and caused them unnecessary anxiety. People often did not know which staff were visiting them, and they found it difficult to establish trusting and positive relationships with staff because of the high turnover and inconsistency of staff.

Complaints received were not listened to and acted upon. We were made aware of a number of complaints made to the registered manager/provider about the service. However no action was taken in response to the complaints made. The registered manager/provider confirmed to us that they did not maintain a record of complaints made. This was despite their own policy stating that all complaints including verbal complaints must be dealt with, recorded and investigated.

People did not receive care which was responsive to their needs. One person’s care need requirements had not been planned for despite them having a variety of complex needs. This meant that staff did not have the information they needed to enable them to provide the person with the right care. A family member told us that they were unaware of a care plan for their relative and neither of them had been asked to sign one.

The required improvements had not been made to ensure effective systems were in place to assess, monitor and improve the quality and safety of the service. People who used the service, family members and staff lacked confidence in the leadership of the service. They were unsure about the management structure and staff felt unsupported by the registered manager/provider. There were no audit systems in place to assess, monitor and improve the quality and safety of the service. This resulted in the registered manager/provider failing to identify and act upon serious issues that we identified.

Following the visit CQC took urgent action and placed a condition on the registration of the provider to ensure that they do not accept any new service users at Care & Connect.

You can see what other 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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Care & Connect is a domiciliary care agency, providing personal care and support to people living in their own homes. The service operates from an office based in St Helens, close to the town centre. There were 57 people using the service at the time of our inspection.

The service has a registered manager who was registered with CQC in October 2016. 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.

This was the first inspection of Care & Connect since the service was registered with the care Quality Commission in July 2016.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Recruitment of new staff was not always safe and thorough. The required reference checks were not always obtained for staff employed. References obtained for some staff employed did not correspond with their employment history and other references obtained had not been verified. The lack of robust recruitment checks put people at risk of receiving care and support from staff of unsuitable character.

Aspects of the service were not monitored to ensure all risks to people were identified and mitigated. Checks had not been carried out ensure records were properly maintained and complete. This included checks on recruitment and accident and incident records. The lack of robust record keeping put people at risk of not receiving safe and effective care.

We have made a recommendation about staff training on the subject of moving and handling. Although staff had completed moving and handling training the practical element of the training was delivered by a person who was not suitably qualified, which meant people's safety was put at risk.

We have made a recommendation about staff supervision. Staff had received one to one supervisions whereby they met with the registered manager at the office to discuss their work and training and development needs. However there had been no direct observations carried out on staff performance in the workplace as a way of assessing their competence and learning and development needs.

People were kept safe and protected from abuse and avoidable harm. Staff had access to training and policies and procedures which provided them with information and guidance about how to keep people safe. Topics covered included; safeguarding people and health and safety procedures in the work place such as first aid, fire awareness and risk management.

People received their medication at the right times by staff that had completed the relevant training. The support people needed with taking their medication was clearly documented in their care plan and staff were provided with training and guidance in relation to the safe management of medicines.

New staff were inducted into their role and they received ongoing training in key topics relevant to people’s needs, their roles and responsibilities. Staff told us they benefited from the training ndertaken and they said they could always rely on the registered manager for support. They described her as being approachable and supportive.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA). Staff were aware of the need to obtain people’s consent prior to them providing any care and support.

People received support by the right amount of suitably, skilled and experienced staff. Staff arrived at people’s homes on time and stayed for the full duration of the contracted call. People were notified in advance of any changes to visit arrangements, such as if there was a delay or a change in staff. There was an electronic system in place at the office which enabled the registered manager to monitor the punctuality and duration of calls.

People’s needs which had been assessed were clearly documented in a plan of care which was kept at their homes. Care plans took account of people’s wishes and preferences and they were kept under review to ensure they always accurately reflected people’s needs and preferences. Visit records which were maintained detailed the support people received and they were an effective way for staff to communicate onto relevant others important information about people’s needs.

People who used the service and family members described staff as friendly, patient and caring. They told us that staff were respectful of their wishes and of their home environment. People’s right to privacy and independence was understood and promoted by staff. Staff encouraged people where possible to do as much as they could for themselves.

People were provided with information about the service, including how to complain. People had no worries about complaining should they need to and they were confident that their concerns would be dealt with properly. People’s views about the service were obtained both on an informal and formal basis. They were given the opportunity to rate and comment on aspects of the service through the use of questionnaires and less formally by speaking directly with the registered manager.

The management structure was understood by people who used the service, family members and staff. People told us they had no difficulties speaking with the registered manager if they needed.