Background to this inspection
Updated
20 October 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 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.
This inspection took place on 7 and 8 August 2018 and was announced. The provider was given notice because we needed to be sure that the registered manager was available. The inspection was carried out by two inspectors. The inspectors visited the agency office on 7 August 2018 and made telephone calls to people who use the service, relatives and staff on 8 August 2018.
Before the inspection we reviewed the information we held about the service. This included looking at information we had received about the service. We also contacted the local authority contracts and safeguarding teams.
We had not asked the provider to complete a Provider Information Return (PIR) prior to this inspection. 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.
During our visit to the agency office we spoke with the registered manager and the Company Director. We looked at the care records of six people who used the service, four staff recruitment files, training records and other records relating to the day to day running of the service.
We spoke on the telephone with six people who used the service and/or their relatives. We also spoke with four care staff.
Updated
20 October 2018
1st Calder Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to people over the age of 18 years. Not everyone using 1st Calder Care 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. Where they do we also take into account any wider social care provided. There were 13 people receiving personal care when we inspected.
This inspection took place on 7 and 8 August 2018 and was announced. The provider was given short notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies to make sure the registered manager would be available.
At our previous inspection in January 2018 we rated the service as ‘Requires Improvement’. We identified four regulatory breaches which related to safe care and treatment, staffing, person-centred care and good governance. This inspection was to check improvements had been made and to review the ratings.
The registered manager who was in post when we inspected in January 2018 left the service. A new manager was employed who registered with the Commission in July 2018. 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.’
Although we found some improvements had been made at this inspection, concerns remained in several areas. We found continued regulatory breaches in relation to safe care and treatment (medicines), person-centred care, staff training and good governance. We also identified two new breaches in relation to staff recruitment and consent.
Medicines management was not safe as records were incomplete. This meant we could not be sure people were receiving their medicines as prescribed.
Not all staff had a full understanding of safeguarding or had received training in this area. Safeguarding incidents were reported to the local authority safeguarding team. Assessments identified risks to people, although some of these required more detail to show how the risks were managed.
Staff recruitment procedures were not robust as thorough checks had not been completed before staff started working in the service. Moving and handling training had improved, however, staff had not always received the induction and training they required to carry out their roles.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
There were sufficient staff to meet people’s needs and provide a flexible service. People and relatives were happy with the service provided. They told us staff usually arrived on time and stayed the full length of the call. They said staff were caring and respected people’s privacy and dignity. People’s nutritional needs were met and people had access to healthcare services.
People’s care plans contained basic information but there was a lack of detail to guide staff during care delivery and some aspects of people’s needs were not included in the care plan. There was not enough detail to guide staff about the care and support people required.
The registered manager told us there had been no complaints, however, we found two complaints. Although both had been dealt with they had not been recognised as complaints or recorded as such. The provider’s systems and processes did not enable them to effectively assess, monitor and improve the service.
The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. 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 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.