Archived: 1st Calder Care Ltd

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.

1st Calder Care Limited 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 the agency 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. At the time of our inspection 12 people were receiving personal care.

The service had a registered manager. 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’s systems and processes did not enable them to effectively assess, monitor and improve the service. They did not monitor and mitigate risk effectively. The provider had failed to notify CQC of incidents which are legally required to be reported.

We found medicines were not managed safely as records were incomplete so we could not be assured people had received their medicines as prescribed.

There were inconsistencies in how risks to people were managed. Environmental risks were assessed and mitigated, yet individual risk assessments contained very little information.

The registered manager was not able to provide us with any documentary evidence to confirm staff had received the induction, training and support they required to carry out their roles and meet people’s needs.

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. People said staff never rushed them and if they had time left over staff sat and chatted with them. Staff were satisfied with the staffing arrangements although they told us travel time was not scheduled which sometimes caused them to be late for calls. The registered manager told us this was being addressed. Staff recruitment procedures ensured staff were suitable to work in the care service.

Safeguarding incidents were recognised, dealt with and reported appropriately. There were systems in place to manage complaints.

Relatives praised the staff for their kindness and caring manner. Staff we spoke with knew people well and respected people’s privacy and dignity. People’s nutritional needs were met and they were supported to access healthcare support as and when needed.

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.

People’s support plans varied in quality and were not always person-centred. There was a lack of information to show the support people required from staff at each call, what the person could do for themselves and any preferences.

The registered manager recognised improvements were needed and told us they were introducing a new computer programme by the end of February 2018 which they felt would help them address many of the shortfalls we identified at this inspection.

We identified five breaches in regulations relating to safe care and treatment, person-centred care, staff training, good governance and notifications. The breach relating to notifications will be dealt with outside of this inspection process. You can see the action we have told the provider to take in relation to the other breaches at the end of this report.