Archived: Your Care

Updated 13 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 was prompted in part by people and their relatives telling us that they had not received scheduled calls from the service. It took place on 10, 11, 14, 15 and we contacted the relatives of people who used the service by telephone. The first day of the inspection was unannounced.

The first two days of the inspection were conducted by an adult social care inspector. Days three and four of the inspection were conducted by two adult social care inspectors.

Before the inspection we spoke with the local authority’s quality assurance team who had raised concerns about the service and looked at the information that the CQC held about the agency.

During the inspection we spoke with two people who received care from the agency, the registered provider and the administrator. We spoke with the relatives of 10 people who received care from the agency.

We looked at the staff files for seven staff members. We also looked at the care files for 12 people, including care plans, assessment of needs and any other records available relating to people’s care. We also looked at the computerised rostering system and obtained printouts of the rosters for upcoming days.

Updated 13 February 2018

This inspection took place on 10, 11, 14 and 15 August 2017. The first day of the inspection was unannounced. Your Care is a domiciliary care agency providing care and support for people living in their own homes in the geographical area of Wirral. The provider was registered with the Care Quality Commission for the regulated activity of personal care. The service does not require a registered manager, as it was managed by the registered provider. This was our first inspection of the service since their registration in September 2016.

At the time of our inspection we believe there were 51 people receiving a service from Your Care. The agency was responsible for providing in the region of 120 calls per day.

During this inspection we found breaches of Regulation 9, 10, 11, 12, 13, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 of Care Quality Commission (Registration) regulations 2009; failure to notify the Commission of notifiable incidents.

People who required essential care and support to take their medication received an unreliable service. The registered provider lacked oversight of the organisation and was not able to ensure that all vulnerable adults received the calls they needed to meet their needs.

We saw evidence of occasions and people’s family members told us that people were left hungry and waited for food, did not receive medication that was essential for their health and wellbeing and people were put into situations where their dignity was compromised.

People’s relatives told us that they had made frequent complaints. They said issues were not resolved; communication when raising issues was poor and they did not feel listened to. One person’s family member told us, “Their communication was absolutely diabolical, the worst ever.”

We found that staff rosters were poorly planned and staff members were deliberately double booked at up to five places at once; this is referred to as ‘call cramming’. This meant that it was impossible for people to receive their care when it was needed. It was inevitable and obvious to the registered provider that people would be forced to wait for their care for hours without any explanation or warning.

The process for assessing risks to people was poor. The service did not have an effective risk screening process in place to identify and mitigate the risks associated with people’s care needs. This lack of assessment meant that significant risks in people’s care had not been highlighted or addressed. There were many examples of serious omissions that meant that staff members did not have access to essential information needed to care for people safely.

The registered provider had no oversight of risks or the risk assessment process within the agency. This placed people at unnecessary increased risk of avoidable harm.

The processes for ensuring that staff that had been recruited were suitable for the role of working with vulnerable adults were inadequate and incomplete. We looked at the staff files for seven staff members. We saw that the registered provider had failed to complete their obligations to ensure that people employed were suitable and of good character for all of the seven staff files we looked at. For recently recruited staff members the registered provider had also failed to obtain a disclosure and barring service (DBS) check. A DBS check looks at any criminal records a person may have and checks to see if people have been placed on a list barring them from working with vulnerable adults. The registered provider had not taken steps to ensure that people employed were fit and proper persons for the role. This placed vulnerable adults at risk.

There was no evidence that staff had been inducted into their role or received appropriate support. We saw no structured method being used by the provider of assessing the performance and suitability of staff in their role of supporting vulnerable adults.

The registered provider did not appear to be aware of the seriousness of their lack of oversight and the significant risks this posed to the people relying upon the service for their care. It is by chance that this combination of a lack of oversight of the service, inadequate records, inadequate risk assessing, inadequate rostering, unsafely recruited care staff, missed calls and missed medication had not led to a vulnerable adult suffering significant harm.

On 22 August 2017 CQC used its urgent powers to keep people safe.

The provider has 28 days to appeal against this action to the First Tier Tribunal (Care Standards) under section 32 (1) (b) of the Health and Social Care Act 2008. Once this period has passed, the action will be reported upon.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special

measures' by CQC.

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.