Archived: Generations and Companions Care

Updated 22 March 2017

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.

We undertook an announced inspection on 1 and 4 July 2016 with one adult social care inspector. The final day of inspection was the 8 July and two adult social care inspectors visited the service. The registered provider was given 24 hours' notice of our intention to visit because the location provided a domiciliary care service and we needed to be sure that someone would be in.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR and we took this into account when we made the judgements in this report.

On the day of our inspection, there were eight people using the service; eight care staff and the registered provider supported them.

Before the inspection, we looked at relevant information as to the registered provider's activities since their registration with the Commission. We reviewed any complaints, safeguarding concerns and intelligence provided to us about the service.

On the days of the inspection visit we spoke with the registered provider who was also the manager of the service at one of the registered office locations. We reviewed eight people's care records, eleven staff recruitment and training files and looked at quality audit records, policy and procedures and other records relating to the service.

We also spoke with five people who used the service and two relatives. We also met with two care staff.

We also spoke with colleagues in Cheshire West and Chester Local Authority about the service who did not share any current concerns.

Updated 22 March 2017

Generations and Companions Care Services is a domiciliary care agency supporting people in the Ellesmere Port and Chester area. The service was registered in January 2013 and currently operates from an office address near Ellesmere Port town centre.

At the time of the inspection the registered provider told us that they provided personal care support to eight people.

The last inspection of the registered provider was carried out on 19 September 2014 with the purpose of following up on outstanding concerns identified on 3 November 2013. The registered provider was found to meet the outcomes inspected.

This inspection was carried out on the 1, 4 and 8 July 2016. We found that improvements had not been sustained and the registered provider was not meeting legal requirements. We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. We will publish the actions we have taken at a later date.

The registered provider did not have appropriate systems in place to protect people from harm.

Staff recruitment processes were not robust and the necessary checks had not been undertaken to ensure staff had been recruited safely. This meant that people could be at risk of harm as the registered provider did not ensure that staff were suitably skilled, had the right experience or were of suitable character to provide personal support to vulnerable people.

Staff did not receive the required induction, training, supervision and support to undertake their role. New staff did not receive a comprehensive induction and the registered provider could not evidence that they had ensured that staff were deemed as competent before they worked alone. Training provided to staff was inconsistent and there was no evidence to demonstrate that some had received training in key aspects of the role such as medication administration or moving and handling. Therefore, there was a risk that staff did not have the knowledge and skills to provide people with safe care and treatment.

Supervisions or spot checks were not carried out on a regular basis; therefore, staff had not been continually assessed as being confident and competent to carry out their role.

The safe management of medicines was not in place. There was a risk that people would not get their medicines as prescribed. Medication was not always given by staff that had been trained or deemed as competent in these tasks. Some people were at risk as they had not given valid consent to their medicines being given.

Risks to people's health and wellbeing were not appropriately assessed and reviewed. Not everyone had a support plan so there was a risk that staff did not have sufficient and detailed knowledge to provide people's care and support needs. There were no records to demonstrate if support plans were up to date and had been reviewed.

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. Where a person was assumed to have mental capacity, staff gained consent prior to providing care or services. However, where people had some cognitive impairment, arrangements were not in place to formally assess their mental capacity to ensure staff or others acted in their best interests.

The registered provider did not consistently complete a staff rota to demonstrate that there was sufficient staff to meet the needs of people that were supported. However, people told us staff were reliable and they were rarely late. People could not recall being “Let down” or having any missed calls.

Quality assurance checks on the service and care delivery were ineffective and not consistently carried out. Therefore, the registered provider was not able to monitor the quality, safety and effectiveness of the service.

Staff had an understanding of safeguarding and a number of concerns had been highlighted and reported to the local authority. People who used the service told us that they were satisfied with the support and service that they received. They said that the staff were kind towards them and that they felt safe whilst staff were providing support. Family members had no concerns about their relative’s safety or the way their relatives were treated.

There was a complaints process in place but this needed updating to ensure that people were aware of all of the options available to them. People’s complaints were identified as such and addressed. People told us that they were listened to and the “Boss” usually addressed any concerns.

People’s views had recently been sought though a quality questionnaire and no concerns had been raised from those returned at the time of the inspection.

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.