Archived: Good Companions (Manchester)

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of this inspection the service was supporting two people and was delivering 112 hours of personal care each week, with each visit undertaken by two care workers.

Good Companions (Manchester) is part of a franchise organisation, providing domiciliary care and support to people within their own homes. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating.

We last inspected Good Companions (Manchester) in August 2018. At that inspection, we found multiple breaches of regulations, the service was rated Inadequate and placed in special measures. We also served two warning notices against the registered provider for Regulations 17 and 18. Shortly after this inspection the provider agreed to impose a voluntary embargo, which meant they would not take on new packages of care until CQC were satisfied the service had made the necessary improvements. This voluntary embargo remains in place.

At this inspection we identified five continuing breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. People were placed at risk because there was a lack of leadership, governance and managerial oversight of the service.

The service had a manager who had been registered with CQC since July 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.

The provider had continued to fail to ensure that robust governance systems were in place to monitor the quality and safety of care people received. Due to these poor systems, the provider could not be assured that people had received their medicines correctly.

The provider had not ensured there were enough care staff working for the service to cover the care visits required. This has resulted in the registered manager and provider consistently covering these visits which impacted on their ability to co-ordinate, structure and monitor the quality of care being given to people.

Not all staff had received the appropriate training or supervision before they performed certain tasks such as giving people their medicines which put people at risk of unsafe care.

Recruitment processes continued to be inadequate. Staff were being employed before all pre-employment checks were undertaken. This meant people were at risk of harm because staff recruited may not be suitable for the role.

We were not assured from discussions with staff, our observations and a review of care records that staff and the registered manager and provider fully understood their roles and responsibilities in relation to the Mental Capacity Act 2005.

Although we found staff were knowledgeable in safeguarding, training had still not been made available from the provider.

At the time of our inspection, no person was receiving end of life care. We noted that staff had not received training in this area, and care plans did not consider people’s preferred priorities.

The overall rating for this service is 'Inadequate' and the service therefore 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.

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.

You can see what action we told the provider to take at the back of the full version of the report.

Good Companions (Manchester) is part of a franchise organisation, providing domiciliary care and support to people within their own homes. Not everyone using Good Companions (Manchester) receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. The administrative office is located in Whalley Range, Manchester. At the time of this inspection the service was supporting two people and was delivering 42 hours of personal care each week.

We previously inspected the service on 05 July 2017. On that occasion we were unable to rate the service against the characteristics of inadequate, requires improvement, good and outstanding. This was because the service was not fully operational and we did not have adequate information about the experiences of enough people using the service, to accurately award a rating for each of the five key questions and therefore could not provide an overall rating for the service. However, we found at that time the service was not meeting the regulations related to staffing, good governance and fit and proper persons employed.

The service had a manager who had been registered with CQC since July 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.

The registered manager said he would take actions following the previous inspection. During this inspection, they told us a number of actions had been completed, but we found there were ongoing issues which are described throughout this report. People were still placed at risk because there continued to be a lack of leadership, governance and managerial oversight of the service. Quality assurance systems did not ensure people's individual care needs were met, risks were minimised or care was delivered to keep people safe.

We observed staff were kind and caring and treated people with dignity and respect. However, the failures across the service demonstrated there was a lack of care and attention to following safe systems of work, and to meet the requirements of the Health and Social Care Act. There was positive feedback about the service and caring nature of staff from the two people who received the service.

Whilst some risk assessments had been completed in relation to the care people were receiving, we found risk assessment processes were not always adequate. For example, risk assessments were not in place for one person who required the use of a hoist with moving and handling. This put the person at risk of unsafe practise, for example if the wrong size sling was used.

Recruitment processes continued to be inadequate. Staff were being employed before all pre-employment checks were undertaken. This meant people were at risk of harm because staff who had been recruited may not have been suitable for the role.

There was limited monitoring of people's medicines. Record keeping was poor, including in relation to the administration of medicines. Staff were not always signing the medicines administration record (MAR) when they were providing support to people to take their medicines. Staff had not received training in medicines administration.

There continued to be no established training and staff supervision schedules. We saw no evidence that staff received training and an appropriate induction. There were insufficient systems in place for the induction, supervision and appraisal of staff.

There was no evidence that people's mental capacity had been assessed. There was no information to show who was involved with making decisions about peoples' care and no evidence to show that care plans had been discussed and agreed with people using the service or their family member/legal representative.

There were no records of accidents or incidents, and there was no monitoring of accidents such as falls, as staff were not recording these incidents unless they witnessed the actual event.

Although we found staff were knowledgeable in safeguarding, they had not received this training from the provider. We found there was no systems in place to record and report safeguarding concerns and the policy and procedure belonged to another service which was not connected to the provider and did not offer sufficient guidance.

The provider had not submitted a notification to CQC in line with statutory requirements.

At the time of our inspection, no person was receiving end of life care. We noted that staff had not received training in this area, and care plans did not consider people’s preferred priorities.

Information about medical conditions and healthcare professionals involved in providing care were documented in the care records we looked at. However, records relating to the people using the service had not always been updated to reflect people’s current needs.

We saw that initial assessments had been carried out prior to the two people commencing with the service. This assessment identified the specific needs of the person and helped to ensure the right resources were available to support the person in an effective and responsive manner.

There were sufficient and regular staff to provide the level of care needed at this point in time. The two people we visited were being supported by a consistent staff team who knew their individual needs.

People had enough to eat and drink, and received support from staff where a need had been identified. People's individual dietary requirements where met. People were supported to have access to healthcare professionals to maintain good health.

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.

You can see what action we told the provider to take at the back of the full version of the report.

Good Companions (Manchester) is part of a franchise organisation, providing domiciliary care and support to people within their own homes. The administrative office is located in Whalley Range, Manchester. At the time of this inspection the service was supporting one person and was delivering 15.15 hours of personal care to this person each week. On this occasion we were unable to rate the service against the characteristics of inadequate, requires improvement, good and outstanding. This was because the service was not fully operational and we did not have adequate information about the experiences of a sufficient number of people using the service to accurately award a rating for each of the five key questions and therefore could not provide an overall rating for the service.

This was the first inspection since the service was registered with the Care Quality Commission (CQC) in July 2016.

The service had a manager who had been registered with CQC since July 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. The registered manager was not in office at the time of this inspection. The inspection process was facilitated by the nominated individual.

Recruitment processes were not sufficiently robust. Staff were being employed before all pre-employment checks were undertaken. This meant people were at risk of harm because staff recruitment may not be suitable for the role.

Risk assessments were carried out to ensure staff had guidance on how to support people safely. Information was not sufficiently detailed to help ensure staff knew exactly what to do to keep people safe from identified risks.

There were up to date policies and procedures in place to record and report safeguarding concerns and staff had received mandatory training in this area.

The service had a system in place to ensure staff attended visits on time but it did not ensure that staff stayed the allocated period of time. There was also service coverage provided during out of office hours so that the registered manager could be contacted in the event of an emergency. This meant the person supported could always make contact with the service should they need to do so.

There were sufficient and regular staff to provide the level of care needed at this point in time. The person was being supported by staff who was consistent and therefore knew their individual needs.

The service used the care certificate to induct staff who were new to care. Records showed that staff had shadowing experience prior to carrying out their duties unsupervised. This helped to ensure staff were competent to carry out their duties effectively.

There were no established training and staff supervision schedules. We saw no evidence that staff received training following on from induction. We were told following our site visit that further training in moving and handling was to be scheduled in July 2017. We concluded the registered provider needed to give us further assurances that staff were adequately supported to carry out their duties in a safe and effective manner.

Care records demonstrated that people had been involved in making a decision about the care provided. However we noted the one consent form within care records had not been signed.

Information about medical conditions and healthcare professionals involved in providing care were documented in the care record we looked at. This helped to ensure staff had all necessary information to provide proactive support with accessing additional services should the need arise.

The ‘Caring’ domain was not inspected at this time.

We saw that an initial assessment was carried out prior to the person commencing with the service. This assessment identified the specific needs of the person and helped to ensure the right resources were available to support the person in an effective and responsive manner.

Care plans had been recently reviewed and included information about the support required and the tasks to be done at each visit. We previously identified however that aspects of the care plans needed more detail to help ensure staff delivered person centred care.

There was a complaints policy in place. This document did not provide information about other agencies, such as the local authority, that could be approached should a complaint need to be escalated.

We were unable to speak with people and relatives at this inspection but from a feedback questionnaire we noted positive comments about the service had been made and that they would recommend the service to others. One area for improvement had been identified which was out of hours contact for emergencies.

We identified areas for improvement in record keeping, systems development and quality monitoring. These aspects of the service needed to be strengthened to help ensure the registered manager and provider had adequate oversight of the care provision. This would help to ensure people were kept safe from harm and received an effective and responsive service.

There were a set of policies and procedures to guide staff in their roles. These included infection control, whistleblowing and understanding diabetes. The nominated individual told us staff had access to these documents when they visited the office. Some of these policies referred to outdated CQC compliance standards. We made a recommendation the provider should ensure operational policies and procedures are reviewed and updated as appropriate to be fit for purpose and effectively support staff.

The nominated individual told us the franchisor/head office provided support with staffing training and quality assurance processes. This support had not yet been provided due to the small numbers currently supported by the Manchester service.

We found three breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 relating to fit and proper persons, staff training and good governance systems. You can see what action we told the provider to take at the back of the full version of the report.