Archived: Cotswold Care Unlimited

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.

Cotswold Care Unlimited is a small domiciliary care agency registered to provide personal care to people living in their own homes. On the day of our inspection, nine people were being supported under the regulated activity of personal care.

We last conducted a focused inspection of this service on 5 September 2016. This was to follow up warning notices with regard to safe staff recruitment and quality assurance systems issued following an inspection in March 2016. At the inspection in September 2016 we found the provider had not taken all the necessary actions to improve their quality assurance systems. We therefore imposed a positive condition for the provider 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. We also told the provider to take further action to improve the safety of their recruitment processes At our last full comprehensive inspection of the service in March 2016 we told the provider they must take action to improve care plans, risk assessments and staff training.

At this inspection in March 2017, the provider had established safe recruitment practices. People's needs were assessed and proportionate risk assessments put in place to guide staff on how to provide safe care and support. People’s needs were accurately reflected in detailed care plans which contained person centred information about the person's needs. Where risks were identified there were plans in place to show how risks were managed. People care needs had been reviewed. However, the provider still needed to make further improvements to ensure the service was well led.

We identified gaps in staff training. Not all staff had received training in safeguarding or other training to keep people safe, such as managing medication, moving and handling and first aid awareness.

People were supported by staff who could explain how they would recognise and report abuse. 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.

Staff had received regular support from the management. There was evidence of staff having informal or formal meetings to discuss their roles and support they may need to deliver care effectively.

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 we spoke with were positive about the care they received. People provided positive feedback about individual members of staff and told us they treated them with dignity and respect and supported them to make decisions about the care and support they received.

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

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

We inspected this service on 5 September 2016 to assess whether the provider had taken the necessary actions to meet the warning notices. At the time of this inspection there were 16 people using the service of which seven were receiving support under the regulated activity of personal care.

This report covers our findings in relation to the warning notices we issued therefore we have not changed the ratings since the inspection in March 2016. The overall rating for this service remains ‘Requires Improvement’. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cotswold Care Unlimited on our website.

At this inspection, we found the provider had taken some action to address the issues highlighted in the warning notices but further improvements still needed to be made.

At our last inspection in March 2016 we found people were supported by staff that had not undergone required checks to ensure they were suitable to work unsupervised. This was a repeated breach from the inspection in October 2013. At this inspection we found staff had still not had the required checks to ensure they were suitable to work unsupervised.

At our inspection in March 2016 we found the provider had not established and operated effective quality assurance systems or processes to ensure compliance with the Regulated Activities Regulations 2014. Therefore the quality of the service could not be effectively assessed, monitored and improvements made where needed. At this inspection, there was still no evidence audits were in place to ensure the quality of the service.

At our inspection in March 2016, we found the provider was failing to assess, monitor and mitigate the risks to people's health and safety during care delivered. People's care plans did not contain risk assessments. This meant there was no information if there were any potential risks to people when delivering their care and no guidance for staff on how risks should be managed. We also found that there were no processes to record whether concerns about people raised by staff to management had been acted upon. At this inspection, none of the care files we looked at had risk assessments in them. The provider said they had a system for monitoring concerns but they were unable to produce evidence of this system during the course of the inspection.

At our inspection in March 2016 we found people’s care records were not accurate or complete. People's support plans did not always have all the relevant information to ensure the care required was documented to ensure it was delivered in accordance with their assessed needs. At this inspection we saw improvements had been made and there was information in people’s records detailing what support people needed.

At our inspection in March 2016 the provider was unable to evidence that people were involved in developing and reviewing the care and support that they needed. We saw no assessment records gaining information on what needs people had to form a support plan and people had not undergone regular reviews of their care. At this inspection, the care plans had been updated following the last inspection and the provider said they would be reviewing the care plans as needed or a year after they were completed.

Our inspection in March 2016 did not find that the provider had sought or acted on feedback from individuals and professionals for the purposes of continually evaluating and improving the service. At this inspection, we saw that the provider had sought people’s views on the service, and the records we saw showed people were happy with the support they received.

We found the registered provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering the action we will be taking.

Cotswold Care Unlimited is a domiciliary care agency providing personal care in peoples own homes. On the day of our inspection, 15 people were being supported.

We last inspected this service in October 2013. At this inspection we found staff had not undergone the necessary checks during recruitment to ensure they were safe to work with people. We issued the provider with a requirement notice requiring they address these concerns. At this inspection we found the provider was still not following recruitment procedures to ensure staff had received the full range of checks required.

There was a registered manager in post. 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.

People told us they felt safe. However, no risk assessments had been completed in respect of people’s personal care. People were supported by staff who could explain how they would recognise and report abuse. This could put people at risk as they were being supported by staff that did not have all the skills or training necessary to do their roles safely.

Not all staff had documentation to show thorough recruitment checks had been carried out in line with requirements, such as seeking references and checking employment history of staff.

Staff had not received regular support from their line manager. There was no evidence of staff having informal or formal meetings to discuss their roles and support they may need to deliver care effectively.

Not all staff had received training in safeguarding or other training to keep people safe, such as managing medication, moving and handling and first aid awareness. No training had been provided on the Mental Capacity Act (MCA) 2005. The MCA provides a legal framework to assess people’s capacity to make certain decisions, at a certain time. Not all staff we spoke with were clear on the requirements of the MCA.

People told us they benefitted from caring relationships with the staff. All people we spoke with were positive about the care they received. There were sufficient staff to meet people’s needs and people received their care when they expected.

The service was not well led. There were no systems in place to monitor the quality of service provided. Audits of procedures and systems were not conducted and accidents and incidents were not logged. The support plans were not detailed or clear about when people received support or what support was specifically required.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

People were supported to make decisions about their care and their day-to-day lives. They were also supported to be as independent as possible.

We found that recruitment systems did not include the full range of checks required, files which related to five staff did not have completed application and experience details, health questionnaires, a recent photograph and written references.

The people and their relatives told us that they appreciated this home care service being relatively small, immediate and accessible. They appreciated what one relative called a 'personal service'. Everyone stated that carers were always polite and respected their dignity.

One relative said they were 'very satisfied' and that 'everything's working a treat'. A person informed that their carers were 'never late' and 'I can't honestly complain'.

People and their representatives were asked their views about the service and these were listened to and acted upon. There was a system to monitor the quality of the service that people received and to make improvements when needed.