Archived: Chrismark Care

Chrismark Care is a domiciliary care service which provides personal care to adults with a range of support needs in their own homes. At the time of this inspection the service was supporting eleven people.

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

The provider did not have effective recruitment procedures in place to make sure staff were of suitable character and background to work with people using the service. Staff did not fully understand what it meant to protect people from abuse. The systems in place to ensure people received their medicines as prescribed were not effective. Accidents and incidents were not consistently recorded or analysed, which meant staff could not learn from these events.

Staff were not provided with relevant training and ongoing support to make sure they had the right skills and knowledge to support people. Staff did not fully understand the requirements of the Mental Capacity Act 2005. 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 and in their best interests; the policies and systems in the service did not support this practice. Care records were not fully completed and risks to people were not always assessed and monitored.

The provider’s policies and procedures were out of date, which meant they didn’t reflect current legislation and good practice guidance. Where there were systems and processes in place to monitor and improve the quality of the service provided these were ineffective. The registered manager did not have a clear understanding of their regulatory responsibilities. Their continued failure to take action in response to previous inspections had led to ongoing breaches and shortfalls.

People who used the service and their relatives spoke highly of the care and support they received. Staff told us they felt supported by the registered manager (who was also the provider). However, the lack of effective systems and processes in all areas of service delivery left people at risk of harm.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 18 May 2020) and there were multiple breaches of regulations. As a result of the COVID-19 pandemic we did not take enforcement action. Instead, we met with the registered manager and they provided evidence to show what they had done to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

This service has been in special measures since 19 August 2019. During this inspection the provider was unable to demonstrate that improvements had been made. The service remains rated as inadequate overall.

Why we inspected

We carried out an announced comprehensive inspection of this service on 19 and 25 February 2020. Breaches of legal requirements were found in relation to fit and proper persons employed, good governance, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, and need for consent.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion (caring and responsive) were used in calculating the overall rating at this inspection. The overall rating for the service has remained as inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chrismark Care on our website at www.cqc.org.uk.

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 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 continued breaches in relation to fit and proper persons employed, good governance, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, and need for consent at this inspection.

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.

Special Measures

The overall rating for this service is inadequate and the service remains 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.

Chrismark Care is a domiciliary care agency providing personal care to six people at the time of our inspection. Not everyone who used the service received 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

Systems and practices were not in place to safeguard people from abuse. Staff had not received safeguarding training. The service had failed to safeguard people from abuse of their privacy and liberty. Risks to people were not assessed and so their safety was not managed and monitored, for example, people had not had risks assessed and their care plans did not contain risk assessments. People did not always receive their care from consistent and regular staff. Medicine administration records were well-organised however people did not always receive their medicines as prescribed. Staff had good access to personal protective equipment and daily support plans contained details of cleaning. There was no record staff had been trained in the prevention and control of infection and the registered manager confirmed this.

Consent to care was not recorded. 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 and in their best interests; the policies and systems in the service did not support this practice. There was no evidence people had been involved in their care planning or in reviews of their care. Training records were not consistent and staff had not received all of the training they should to support people with their needs. Daily support plans contained information about people’s preferences, for example, what they liked to eat and drink. Records showed people were supported to eat and drink where needed. The service worked closely with District Nurses, pharmacies and GPs. Records showed how staff monitored people’s health and mood at each call, and that appropriate support was facilitated where needed.

Daily support notes gave information about people’s needs which were person-centred. However, more information about people’s life history and social needs could be included. People’s concerns and complaints were responded to but not always fully resolved. Records of these were not kept. There was no one receiving end of life care during our inspection visit, however these needs were captured as part of people’s daily support records. Records showed people were treated with dignity and respect.

The provider's governance framework was not fully operational. Risks and regulatory requirements were not fully understood or managed. The service did not use any governance tools to learn or improve the service. The service had worked with a consultant following the last inspection and was part of an electronic network which provided health and social care updates.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (19 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 19 August 2019. During this inspection the provider demonstrated that improvements have not been made. The service remains rated as inadequate overall.

Why we inspected

This was a planned inspection based on the previous rating.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to consent, safety, safeguarding, audits and risks, registered manager responsibility, staff training and recruitment and non-notification of incidents at this inspection.

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Chrismark Care is a domiciliary care agency providing personal care to seven people at the time of the inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is to 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

Staff were not recruited safely and were placed at risk because of this. Medicines were not administered safely and people were placed at risk because of this. People and their relatives told us they felt safe with the care from the service.

People had personalised care plans which were individual to them. People received individualised care. 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 told us they felt staff were well-trained however we found not all staff had received the required training. People were placed at risk because of this. Staff told us they had a thorough induction and got to know people well.

People and their relatives told us the staff were very caring and they got on with them well.

People and their relatives knew the registered manager very well and felt they were very responsive to their needs. There was no evidence of the registered manager undertaking any audits or checks on people’s care records.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 July 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe 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. The provider has not yet taken any action to mitigate the risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chrismark Care on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, good governance, safe recruitment of staff, and a failure to display ratings at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during this inspection is added to reports after any representations and appeals have been concluded. Since the last inspection we recognised that the provider had failed to display their ratings. This was a breach of regulation.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve their standards of quality and safety. We will work with the 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.

Special Measures

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.

At the time of this inspection, three people were receiving support and two care workers were employed. The registered manager also undertook some care worker duties.

There was a manager at the service who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Chrismark Care was registered with CQC on 30 July 2017. The service began operating in January 2018. This is the services first inspection.

This inspection took place on 30 and 31May 2018 and we gave the registered provider short notice of our inspection to make sure the registered manager, some staff and some people receiving support would be available to meet and speak with us.

Staff recruitment records were not robust and did not promote people’s safety.

Risk assessments, to identify and minimise risks, had not been completed for all people receiving support.

Detailed care plans were not in place to ensure an accurate and up to date record was available.

We found limited systems were in place to monitor service delivery.

People receiving support and their relatives spoke very positively about the support provided to them. People told us they felt safe and their care workers were respectful and kind. They said they received a consistent and reliable service that met their needs.

Systems were in place to ensure people received their medicines safely.

Staff were undertaking training relevant to their role. Staff were provided with supervision for development and support.

People were supported to maintain a healthy diet, which took into account their culture, needs and preferences, so their health was promoted and choices could be respected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People said they could speak with their care workers or the registered manager if they had any worries or concerns and they would be listened to.

At this inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulation 17, Good governance and Regulation 19, Fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of this report.