Chinite Home Care

Chinite Home Care is a domiciliary care agency based in the London Borough of Barking and Dagenham. It is registered to provide personal care to younger people and older people in their own homes.

At the time of the inspection, eight people were receiving support with personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People and relatives told us the service was safe. They had live-in care arrangements with regular staff, who had got to know people well.

Medicines were managed safely. Staff were trained and their competency was assessed. People were protected from the risk of abuse. Risks to people’s health were assessed appropriately and managed. Staff were recruited safely and there were sufficient numbers of staff to support people. Infection prevention and control procedures ensured the risk of infections spreading was minimised. Accidents and incidents were reviewed to prevent re-occurrence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received care and support that was personalised for their needs and preferences. People and relatives felt engaged and involved in how the service was run. Quality assurance systems were in place to monitor the service. The registered manager carried out audits to check correct procedures were being followed by staff.

The service worked well with health professionals and social care agencies to provide a good standard of care to people and help maintain their health.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service was Good, (report published on 30 October 2019).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed, to seek assurance about this decision and to identify learning about the DMA process.

This was a focused inspection to review the key questions of safe and well-led only.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chinite Home Care provides personal care to people living in their own homes. At the time of our visit, they were providing personal care to 15 people.

People’s experience of using this service and what we found

People were supported by staff who had been trained and were knowledgeable about reporting and acting on any concerns about people’s safety and well-being. Risk assessments were in place and staff adhered to these for the management of risks to people’s safety. Staffing levels were enough to meet people’s needs and recruitment processes were safe. People’s medicines were managed safely by staff who had received appropriate training. People were protected from the risks associated with the spread of infection.

People received effective care from staff who had the knowledge and skills to carry out their job roles. The service worked in partnership with other health professionals to ensure people received effective care and support. People were supported to eat and drink and maintain a balanced diet based on their needs and preferences. People's needs were assessed before they started to use the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring and treated people with respect and dignity. People were encouraged to be independent. They had their privacy and dignity respected. People were involved in making decisions about their care and the support they received. The importance of confidentiality was understood and respected by staff.

People received care and support which was personalised to their wishes and responsive to their needs. Staff had a good understanding of people’s needs, choices and preferences, and were aware of how to meet people’s individual needs as they changed. People and relatives felt able to make a complaint and were confident that complaints would be listened to and acted on.

People, relatives and staff felt the management team was approachable and the service was managed well. Staff were aware of their responsibilities in ensuring the quality of the service was maintained. There were effective systems in place to seek people’s views and opinions about the running of the service and drive improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection the service was rated good (published 24 July 2017). The service was previously registered at a different address.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We carried out an announced comprehensive inspection of this service on 17, 18, 21 November 2016. The provider was given 48 hours' notice of our visit because they provide a domiciliary care service and we needed to be sure staff would be available at the location to meet with us.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 9 Regulated Activities Regulations 2014 - Person centred care

Regulation 11 Regulated Activities Regulations 2014 - Dignity and respect

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 16 Regulated Activities Regulations 2014 - Complaints

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 - Staffing

Regulation 19 Regulated Activities Regulations 2014 – Fit and proper persons

Regulation 18 Registration Regulations 2009 – Notification of other incidents

The overall rating for this service was 'Inadequate' and the service was therefore placed in 'Special Measures'. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the registered provider's registration of the service, we will inspect them again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

We took enforcement action and served a Notice of Decision putting conditions on their registration which told them they must not take on any more people to provide care for and must not agree to increase the level of personal care being provided to current people using the service, without our written agreement. Additional conditions placed on them were that they report to us about how they recruited staff, arranged the staff rotas, checked the competency of the staff and how their quality assurance systems checked that care plans and risk assessments reflected the needs of the people who used the service.

We sent an urgent action letter requesting information and an action plan. We gave the provider until 24 November 2016 to ensure they complied with the Notice of Decision. The provider sent us a comprehensive plan with the actions they intended to take.

At this inspection in May 2017, we found the service had made significant improvements and that all the breaches of the regulations found in our visit in November 2016 had now been met. The provider had also met the conditions which we had imposed on them and had embraced the opportunity to learn from the mistakes made and embed the necessary improvements. In order for these improvements to be sustainable in the longer term, we have proposed to keep two of the conditions, (staff rota arrangements and quality assurance), in place which we will review at a later date.

The service had a registered manager in place. 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 had revised the risk assessments and care plans to ensure they were aware of how to support people to remain safe in their homes and to be as independent as possible.

There were sufficient staff to meet people’s needs and to manage risk safely. Improvements had been made to the checks carried out on new staff to ensure recruitment was robust and safe.

The registered manager and staff had taken steps to ensure that accurate medicines records were maintained and improved checks helped ensure people were receiving the medicines they needed.

Staff had access to relevant training and regular supervision to equip them with the knowledge and skills to care and support people effectively. Staff were kind and caring and treated people with dignity and respect.

The legal requirements of the Mental Capacity Act 2005 (MCA) were followed when people were unable to make specific decisions about their care. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves.

Support with food and drink of people’s choice was provided and records kept if staff had concerns. Staff worked in cooperation with health and social care professionals to ensure that people received appropriate healthcare and treatment in a timely manner.

Systems to monitor the quality of the service had been implemented which had improved the quality of the service which people received. These included systems to support people if they wished to complain or raise concerns about the service. The provider had appropriately notified the Care Quality Commission of any significant events as required by law.

Effective management systems had been put in place from lessons learnt which included a firm infrastructure, strong leadership and a staff team with the skills and knowledge to manage the service into the future and sustain the improvements made.

This comprehensive rating inspection took place over three days on the 17, 18 and 21 November 2016, our visit on the 17 November 2016 was announced. The provider was given 48 hours' notice of our visit because the location provides a domiciliary care service and we needed to be sure staff would be available to meet with us.

During this comprehensive inspection we found multiple breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. 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.

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 registered 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 registered 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. This will lead to cancelling their registration or to varying the terms of their registration.

The company had a registered manager and a nominated individual in this service. 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. An organisation needs to have a nominated person who acts as the main point of contact for us. They must also be employed as a director, manager or secretary of the organisation, so that they have the authority to speak on behalf of the organisation. The registered manager was not in the country when we visited; an acting manager had been appointed but had only been in post for four weeks. Prior and during this inspection the acting manager had identified many of the concerns we found but had not had sufficient time to make improvements. The acting manager had also recruited a compliance manager and a care co-ordinator.

Risk assessments and risk management plans did not provide staff with clear guidance about how to safely manage known risks to people. They were not always up to date, which meant they did not reflect people's current needs.

Medicines were not managed consistently and safely. Safe medicine administration practices were not followed so people were not protected against the risks of unsafe management of medicines. Out of 22 staff files checked, 15 did not have up to date training in managing medicines or any checks to assess that they had the required competency to manage medicines safely.

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Staff could not identify the signs that someone may be being abused. The service did not have clear systems in place to report and investigate abuse and incidents were not always referred to the appropriate agencies. Action was not taken where evidence was found that staff had not carried out the correct procedure or needed to be retrained. Two safeguarding alerts were raised with the local authority following our inspection.

Consent to care was not always obtained. Where people were unable to consent to their care, due to their mental health difficulties or understanding, the service had not completed mental capacity assessments or recorded best interest's decisions.

Safe recruitment checks were not carried out before staff started work and not all staff were suitable to work in a care setting. Staff were not regularly supported to carry out their work and had not been given regular support or training.

People who used the service were exposed to being supported by staff who may not be suitable to work with vulnerable adults. Risk assessments were not in place in place to reduce the risk after employing people with recent criminal convictions.

Information was not available to assess how the service worked with health care professionals to support people with particular nutritional needs; care records lacked this depth of information.

People told us most care staff were friendly and caring. Some people told us staff provided them with care which promoted their independence.

The service had an up to date complaints policy and people told us they knew how to raise concerns. At the time of our visit there had been no complaints received by the service so we were unable to establish how they deal with any complaints. The acting manager had created a complaints file but was not aware of any historical information.

The service did not have clear management or governance systems in place. The provider had not always notified the commission when incidents had occurred.