Archived: Classique Care Services Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question good. At this inspection, the rating has changed to inadequate. This meant people were not safe and were at risk of avoidable harm.

The service was in breach of regulations in relation to person centred care, risk management, safe and effective staffing and the safe administration of medicines.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not fully investigate safety events. Lessons were not learnt to continually identify and embed good practice.

People and their relatives told us when they raised safety concerns, these were either not listened to or were initially acted upon but then lapsed back into previous patterns.

The manager did not maintain an accurate log of safeguarding events or accidents and incidents. This meant there was no overview of all such incidents and the manager was unable to identify trends or patterns that might then be addressed to reduce the likelihood of re-occurrences. Staff were not kept informed of any lessons learnt. The provider was in breach of the legal Regulation and 12 (2) (b), Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The records we viewed did not consistently show there was a proactive culture in place regarding safety incidents or concerns and that they had been effectively reflected upon and used to drive improvement.

The provide was in breach of Regulation 17(2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

People we spoke with told us they frequently experienced late or missed calls and that communication with the office was poor. Analysis of the electronic call monitoring system evidenced a high proportion ofcalls were more than 15 minutes late and some were more than 45 minutes late. Data we reviewed also evidenced some calls delivered were for less than half the planned time. Late calls for people needing to receive their medicines at a specific time, could have placed them at risk of harm. The provider was in breach of the legal Regulation 12(2) (a) and 12 (2) (b), Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Some people told us they did not feel safe because they were not supported with their care by regular staff who knew them. Comments included, “Different carers who are not familiar with my care needs, so more frustration for me again”, “Some carers are trained, with the different carers I get I don’t feel safe”, “My regular carer makes it a pleasant visit but I need a regular carer, it isn’t so pleasant when I get carers I don’t know ”, “I get on well with the carers I know”. The provider was in breach of the legal Regulation 17 (2) (b), Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

The provider had failed to understand the impact the poor quality of service was having on people, and this put people at risk of neglect and avoidable harm.

Staff said they were aware of some of the policies and procedures to follow. In our discussions with staff, they understood what to do to ensure people were protected from abuse. Staff said they had had training on safeguarding people from abuse. Information provided for us showed 86% of staff had completed safeguarding training.

The manager told us they were aware of their duty to notify CQC of significant events, however up to the time of this inspection, they acknowledged appropriate notifications had not been made to CQC as required. The managerdid not maintain an accurate log of safeguarding events or accidents and incidents. This meant there was no overview of all incidents, and the manager was unable to identify trends or patterns that might then be addressed to reduce the likelihood of re-occurrences. The provider was in breach of the legal Regulation 13 (1) and 13 (2), Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider did not do all that was reasonably practicable to mitigate risks. Risk assessments were unsigned and undated. Where risks such as a risk of a person falling or for people who self-medicated were identified in referral information, there were no associated risk management plans in place. This meant people could be at the risk of potential harm and staff were not provided with the correct guidance to support people safely. Staff were not able to demonstrate how they helped people to independently manage their individual risks.

There were mixed views from people and their relatives about their care plans. Some said that they had a care plan, but some people were unsure whether or not they had a care plan. Some people said they had been involved in the process and those people told us they felt staff understood the needs and risks associated with their care and support. Comments included: “Yes, I was involved in putting my care plan together. I get the care I need”, “Care plan? I believe so”, “Care plan, no care plan”, “Care plan, no, my care is not logged.”

Care plans that we inspected were unsigned by either staff or people and some were undated. This meant we could not be assured care plans were agreed by people or their relatives or if they were still appropriate to meet people’s needs.

People and/or their relatives gave us negative feedback about communication with the office. There were one or two positive comments, but these were far outweighed by the negative ones. Comments included: “Poor communication with the office, this is associated with poor time keeping”, “Communication with the office? I text they don’t respond”, “There is no contact from the office to inform me of late arrivals”.

Systems in place to review risk assessments and risk management plans were ineffective. The provider was in breach of the legal Regulation 12(2) (a) and 12 (2) (b), Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

The provider’s practices for staff recruitment were not robust and did not meet regulatory requirements. Four staff started in their job roles prior to an enhanced DBS being received. On inspection of the staffing records, we found that the Operations Manager did not have a staff file and 3 of 6 staff files had only one personal reference on file and no professional references. This meant the provider could not be assured their recruitment processes were safe. The provider was in breach of the legal Regulation 19 (2), Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s feedback about how well trained their care staff were included these comments: “Some carers are trained, different carers are not trained”, “My carers seem well trained and familiar with my needs”, “Staff training, yes. You get the odd one who is not well practiced for the job”.

Staff told us they received induction training. They said this included a period of shadowing more experienced staff. Records provided over this inspection evidenced that 25% of all staff had received induction training.

Staff said they received a range of subsequent training that included safeguarding, medicines awareness, food safety, infection control and wound care. They said their training did not include risk assessments and staff who supervised other staff said they received no specific training to enable them to do so.

Evidence of training for staff, showed a partial completion of induction training by staff and only partial completion of all training provided. This meant that not all staff completed essential training and therefore may not have been sufficiently qualified or skilled to meet people’s needs effectively. Staff who provided training to colleagues were not qualified to do so. This meant we could not be assured the training provided met the necessary standards.

Staff who assessed the competencies of other staff in staff supervision and for example, in the safe administration of medicines, had only received a basic level of training. This meant we could not be assured staff competency assessments were appropriately carried out to ensure all staff were administering medicines safely.

The frequency of staff supervision was not in line with the providers own policy. Some staff had only received this support once over the last year. Records were so brief there was no detail as to the discussion that took place and therefore, they did not provide a useful record for managers or staff. This meant we could not be sure staff supervision provided the level of support and training to staff that was necessary. Records provided for us at the inspection evidenced that no staff appraisals were carried out.

At the time of this inspection the website for Classique Care stated that all staff were trained to NVQ level 2, there was no evidence to support this in the training evidence provided. When we raised this with the nominated individual, they acknowledged this and have subsequently removed this and other misleading information from their website. The provider was in breach of the legal Regulation 18 (2), Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Records relating to care and staffing were not always accurate or kept up to date and fit for purpose. For example, staff records were not well maintained and up to date. It was difficult to get clear information as to the names and numbers of staff employed as care workers. Similar issues were experienced with service user information. Initially we were told there were 26 service users who received personal care, a regulatory activity. Records provided for us supported what we were told. However subsequently we received information from the commissioners that there were in fact 126 service users. This indicated the provider and the manager had an inadequate working knowledge of the most basic information and poor record keeping. The provider was in breach of the legal Regulation 17 (2) c, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Staff had received training in infection prevention and control (IPC) last year. The training delivered to staff was in house. There was no evidence provided to show the trainer was qualified to provide training. This put into question the effectiveness of the training staff received. However, staff we spoke with knew what safe IPC practices were when supporting people and were able to explain how they ensured safe IPC when delivering personal care. New training has been arranged for staff and some staff have since completed this training.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

22% of staff not completed Medicines Administration training. The electronic system created an alert when medication was missed, but these were not individually risk assessed, reviewed or audited. There was no evidence that time sensitive medication was managed appropriately. Given the high number of missed and late calls this posed a risk of harm to service users. Whilst MAR charts held in service user homes were audited, this was not consistent or effective.

People and their relative’s comments about the support they received to do with their medicines were mixed and included, “Medicines, my carer should remind me. In fact, it’s the other way round, I have to remind them. It would be really bad if my medicines were missed”, “Staff give the medication at each visit. It comes in blister packs, so it is done safely” and “Staff give the medication. Not sure if they stay to see if it’s taken though”.

The provider had in place a system to monitor medicines administration for those people who were identified as needing assistance with their medicines. This was done on an individual basis, however there was no system in place that provided an overall view and therefore trends or errors in staff practice were difficult to identify easily.

Staff who assisted people with their medicines had their competencies assessed, however the assessor had not received appropriate training. This meant we could not be assured supervisory staff could accurately assess other staff’s competencies with medicines.

Guidance for staff to follow in people’s care plans was not specific and where appropriate stated people should be ‘supported’ with their medicines, however whether this meant they should be prompted or assisted in taking the medicines was unclear and could lead to inappropriate support being given to people, leaving them at risk of potential harm. The provider was in breach of the legal Regulation 12(2) (a) and 12 (2) (b), Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.