Archived: Holistic Recruiters Limited

Holistic recruiters are 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 older and younger people some of whom may have a physical disability. At the time of our inspection the service provided a regulated activity to 13 people.

There was a registered manager who was also the sole director of the company. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

This was the first inspection of this service since registration with CQC on the 31 May 2017. We identified major concerns in relation to the quality and safety monitoring of the service. Immediately following our inspection, we wrote to the provider requiring them to inform us of the actions they would take to meet the requirements of the law. We also required the provider to provide us with full information in relation to the numbers of staff employed and details of the people receiving a service. Following their response, we informed the local authority commissioners of our concerns who responded by finding alternative providers for all of the people receiving a service on the same day.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The registered manager did not promote a culture that encouraged candour, openness and honesty at all levels. Throughout our inspection the registered manager provided inconsistent, conflicting, information. They did not have effective systems in place to ensure overall governance of the service and identify the shortfalls we found at this inspection.

People were placed at risk as staff were not provided with the training, guidance and information they needed to keep people safe. Risk assessments were not always in place to address people's needs and reduce the risk of harm. Widespread significant shortfalls in the service meant that people's health, safety and welfare was not upheld.

People were at risk of not receiving their medicines as prescribed. Not all staff who administered medicines had been trained and had their competency assessed to ensure they were safe to do so. Staff did not demonstrate the required knowledge to ensure the safe management of people’s medicines.

There were insufficient numbers of suitably qualified staff to meet people’s needs. Staff were not recruited safely in accordance with the provider's own policy and procedure. Systems to check that people were being supported by staff who had the suitable skills, knowledge and qualifications to meet their needs were not robust. Induction training and safety and competence checks had not always been completed before staff were left unsupervised to care for people in their own homes.

Accidents and incidents people told us had taken place were not recorded. Record keeping in relation to the care provided to people was poor and inconsistent. Guidance was not always provided to staff with action they should take to reduce risks to people’s safety.

The Mental Capacity Act (MCA) 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The registered manager did not understand their role and responsibilities. People’s capacity had not been assessed with information provided to staff in meeting their needs.

Whilst some staff were seen to be kind and caring, people were not always treated with dignity. Further work was needed to embed a culture of caring throughout the service.

There was a policy and procedure for handling complaints, however this was not always being followed. People told us their complaints had not always been responded to appropriately. The registered manager did not record concerns and complaints received in accordance with their own policy which meant complaints had not been dealt with properly. There was a failure to evidence learning from incidents with planning towards improving the service.

No one receiving end of life care. However, staff had not been trained in meeting the needs of people at the end of life. There was no guidance on what to do in the event of sudden death. There was no care plan guidance available to staff as to any assessment of people’s wishes in the event of death or if circumstances changed and they needed palliative care.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of this report.

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.