Background to this inspection
Updated
23 April 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
This was a targeted inspection to check on specific concerns we had about recruitment checks, management of people's medicine, personal protective equipment and staff training.
Inspection team
This inspection was undertaken by two inspectors, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service did not have a manager registered with the Care Quality Commission and were recruiting for this role.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection. We had requested information from the provider prior to the inspection and this information was used as part of the inspection plan.
During the inspection
We spoke with twelve members of staff including the operational manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with one person who used the service and fourteen relatives.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
23 April 2021
About the service
Independent People Home Care Limited is a domiciliary care agency providing personal care to people in their own home. This included a nationwide, 24-hour live-in care service. At the time of the inspection there were 115 people using the service.
People’s experience of using this service and what we found
Staff were providing care to people with complex and extensive care needs. People told us they were not always supported by staff who had the correct skills, knowledge or competence to meet their assessed needs. Some staff told us they needed more training, and that whilst they had been given training this did not adequately meet their learning needs.
We could not be assured when training had been provided to staff that it was carried out by suitably qualified people and was adequate to meet some people's complex needs. Systems were not in place to ensure staff would be appropriately supervised when they were learning new skills but were not yet competent to carry out the task.
Staff had been given training to administer people's medicine. We could not be assured they were competent to undertake the task, as the registered manager had not carried out a competency assessment.
The registered manager told us medicine audits were carried out, but when we requested to see this information, this was not provided.
We found a number of safeguarding incidents which had not been raised with the relevant authorities by the registered manager. Shortly after our inspection, the registered manager confirmed these had been reported. Risk assessments were in place, but for some people these were not comprehensive and did not include an assessment of all of the tasks staff needed to carry out.
The registered manager did not record information relating to missed and late visits and this was not available for us to review. Some relatives told us arrangements to enable staff to take breaks when providing 24-hour live-in care, were not formalised by the care agency and that it was often left to the relative or family member to oversee and arrange. Some staff who provided 24-hour live-in care to people told us they did not always get their breaks.
We have made a recommendation about the environment of the premises.
The leadership of the service did not always support the delivery of high-quality, person-centred care. There was a lack of consistency in how well the service was managed and led. Whilst the COVID-19 pandemic may have impacted on the registered managers ability to carry out routine spot checks. People told us the registered provider made phone calls to check the quality of the service they had received, but that this system was ineffective to address the issues we found. Systems to monitor and check the quality of the service people received were ineffective because, they did not identify the issues we found.
Some people told us communication between themselves and the office was poor and needed to improve. Most people said that once a staff member had been placed in the home, limited checks were carried out. The registered manager had delegated some of their oversight tasks to field care supervisors, and at the time of the inspection, they had two vacancies for these posts. We could not be assured there were adequate systems in place to monitor the service because robust and effective audits were not consistently carried out, to monitor the quality of the service people received.
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 in the service supported this practice.
We looked at infection prevention and control measures under the Safe key question. We have recommended that the service improves their current infection and prevention control measures.
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 this service was Good. (09 October 2018)
Why we inspected
The inspection was prompted in part due to concerns received about safe care and treatment and staff training and supervision. A decision was made for us to inspect and examine those risks.
The inspection was prompted in part by the notification of a specific incident. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.
We have found evidence that the provider needs to make improvements. Please see the Safe, effective and Well Led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
We undertook this focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safe care and treatment. A decision was made for us to inspect and examine those risks.
We inspected and found there was a concern with safe and well led, so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of effective, caring and responsive.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, staffing, safeguarding, meeting nutritional needs, person centred care and good governance. This is because some people did not always receive care in a safe and effective way, because staff were not always trained or competent to meet people’s complex needs. Food was served which did not meet people's needs. People did not always receive appropriate person-centred care and treatment. Checks to make sure people received a good quality of care were either not in place or did not identify the issues we found.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.