24 August 2021
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.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was carried out 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. The registered manager had left. A new manager had started on 08 June 2021, they had started their registration process. This means that the provider was legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 9 June 2021 and ended on 18 June 2021. We visited the office location on 09 June 2021.
What we did before the inspection
We reviewed information we had received about the service including the previous inspection report. We also looked at notifications about important events that had taken place in the service, which the provider is required to tell us by law. The provider was not asked to complete a provider information return prior to this inspection. 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 inspected the service and made the judgements in this report.
We contacted health and social care professionals to obtain feedback about their experience of the service. These professionals included local authority commissioners and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they did not have any information about the service. We used all of this information to plan our inspection.
During the inspection
We spoke with one person who used the service and 10 relatives about their experience of the care provided. We spoke with 10 members of staff including care staff, assessors, coordinators, the manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included six people’s care records and multiple medicines records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including audits, risk assessments and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
24 August 2021
About the service
Curant Care Maidstone is a domiciliary care service providing personal care to 43 younger adults with physical disabilities and adults aged 65 and over at the time of the inspection. When we attended the office to inspect, the service was known as Kare Plus Maidstone. Shortly after the inspection the service changed their name to Curant Care Maidstone.
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
People and relatives had mixed views about the service. Some relatives shared positive experiences, and some had negative experiences. Comments included, “It’s all brilliant. Without them we would be lost”; “It is all running ok now after those problems in December”; “Very happy with the care and support” and “Carers are very thoughtful, I am so pleased with the care. One improvement though would be to notify me of anything such as if a carer is held up.”
Risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. Medicines management was poor. The provider could not be assured that people had received their medicines as prescribed.
Accidents and incidents had not been appropriately recorded, this meant the provider had not taken action when accidents had occurred.
Care plans included people’s individual preferences and interests and personal history. Care plans provided information about what staff should do in each care visit to meet each person’s basic needs but did not provide enough information to meet additional needs such as catheter care, choking and diabetes. The provider was unable to demonstrate that people had received the care they were scheduled to receive.
When people’s needs had changed their assessments and support plans had not always been updated and amended to detail their current assessed needs. Support plans and supporting documentation were not always individualised and person centred. Which meant that people may receive care and support which did not meet their needs.
The service was not always well led. The provider had not carried out the appropriate checks to ensure that the quality of the service was maintained. The provider had failed to identify issues relating to risk assessment, staff recruitment, staff deployment, medicines management, recording and care planning we had identified. The provider had not always notified us of incidents relating to the service. These notifications tell us about any important events that had happened in the service.
People's views and opinions were not always listened to. People had been given opportunities to provide feedback about the service. Surveys and feedback evidenced that people had been surveyed in February 2021. The provider had not made any improvements to the service to act on people’s feedback. People and relatives told us they did not know who was running the service. The provider had not communicated with people and relatives regarding staffing changes.
Staff understood their responsibilities to protect people from abuse. Staff described what abuse meant and told us how they would respond and report if they witnessed anything untoward.
The provider had not maintained complaints records. The provider had not followed their own complaints processes when responding to complaints that had been received.
There were suitable numbers of staff on shift to meet people's needs when we inspected, however there had been issues where in recent weeks where there had been missed and late care visits. The provider had identified this and made some improvements. Staff did not always have enough time allocated to them to travel between care calls. Staff had not always been safely recruited, the provider had not ensured that each staff member had a full employment history. Pre employment checks had been carried out, such as Disclosure and Barring Service (DBS) criminal record checks and reference checks.
The provider ensured people were protected by the prevention and control of infection. Staff had access to enough personal protective equipment (PPE). The provider had not put a robust system in place to ensure all staff were regularly tested to check if they had COVID-19.
The provider and management team have put in place an action plan following the inspection to address the issues found.
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 (published 17 November 2018).
Why we inspected
We received concerns in relation to staffing levels, missed care visits and moving and handling practice. As a result, we undertook a focused inspection to review Safe, Responsive and Well-led only.
We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well led sections of this full report.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Requires improvement. 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 Curant Care Maidstone on our website at www.cqc.org.uk.
Please see the action we have told the provider to take at the end of this report.
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.