Archived: Cotswold Care Unlimited

Updated 25 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 the 28 June and 12 July 2018 and was announced. The provider was given 48 hours’ notice because the location provides a small domiciliary care service and the provider is often out of the office providing care. We needed to be sure someone would be in. This inspection was carried out by two inspectors.

Inspection site visit activity started on 28 June 2018 and ended on 12 July 2018. We visited the office location on both days to see the provider and care staff. We spoke with the provider, the senior team leader and four members of staff. We also reviewed five people's care files, medication administration records, seven staff files, staff rotas, meeting minutes and a selection of records used to monitor the quality of the service. We visited one person in their home to look at records and seek their views on the service. Following the inspection, we contacted three relatives to ask for their views about the service and care staff.

When planning our inspection, we looked at information we held about the service, which included information shared with the Care Quality Commission (CQC) via our public website and notifications sent to us since our last inspection of the service. A statutory notification is information about important events such as accidents and incidents in the home which the provider is required to send to us by law. We also contacted the local authority's commissioning team to ask if they had any relevant information about the service. We used this information to plan our inspection.

The provider did not meet the minimum requirement of completing the Provider Information Return at least once annually. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we made the judgements in this report.

Updated 25 October 2018

We undertook an announced inspection of Cotswold Care Unlimited on 28 June and 12 July 2018. Cotswold Care Unlimited is a small domiciliary care agency registered to provide personal care to older adults living in their own homes. Not everyone using Cotswold Care Unlimited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’ and help with tasks related to personal hygiene and eating. Where they do we take into account any wider social care provided. On the day of our inspection, 11 people were being supported under the regulated activity of personal care.

At an inspection in October 2013, we identified that people were not protected against the risks of poor care because the provider did not have appropriate recruitment procedures in place. This was a breach of Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds with Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to submit an action plan to explain how and when they were going to ensure compliance. At an inspection in March 2016, we found these checks were still not always taking place. We did a focused inspection in September 2016 to follow up enforcement action regarding safe staff recruitment and quality assurance systems. At this inspection, we found the provider had not taken all the necessary actions to improve their quality assurance systems. We therefore imposed a positive condition on the provider’s registration requiring them to submit a monthly action plan detailing audits of people’s care plans, risk assessments and records of their care delivery with a report of action taken or be to be taken as a result of the audits. At the last comprehensive inspection in March 2017 the CQC once again asked the provider to take action to make improvements to how they audited the safety and quality of the service and to audit staffing records, including training and recruitment processes. This action had not been completed. Since the provider had registered with the CQC in 2012 they had failed to meet their regulatory responsibilities as a registered provider at each consecutive inspection.

At this inspection, the provider had still not ensured that safe recruitment practices were being followed. People's needs were not always being assessed to reflect current care needs and risk assessments were not evidencing people’s current risks. This meant staff may not be able to provide safe care and support. The provider was not ensuring that care staff were safely administering medicines, correctly moving people and ensuring that staff understood the principles of the Mental Capacity Act 2005 as training had not always taken place. Not all staff were able to clearly explain how they would recognise and report abuse. Not all notifications had been made in line with the safeguarding policies. Learning from previous inspections and enforcement action had not resulted in the service improving.

Not all people had care plans in place to inform staff of their current needs. We also found that care plans were not being regularly reviewed to reflect any changes.

The provider had not developed all necessary processes and systems to ensure the quality of service provided.

People who used the service told us they felt safe with the care and support that staff provided. There were sufficient staff to meet people’s needs and people received their care when they expected. People who used the service were asked to consent to the care and support provided.

People told us they benefitted from caring relationships with the staff. All people and their relatives we spoke with were positive about the care they received. People told us staff treated them with dignity and respect and supported them to make decisions about the care and support they received.

Where people had care plans, these contained person centred information about the person's preferences, likes and dislikes and personal history.

People and their relatives were aware of how to make concerns known. There had been no complaints or concerns recorded since the last inspection in March 2017.

There was evidence of staff having team meetings to discuss people’s care.

There were widespread and significant shortfalls in the way the service was led with regulations not met and repeated in previous inspections.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of Regulation 15 of the Care Quality Commission (Registration) Regulations 2009

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.”

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.