Archived: Carepath Recruitment Ltd

Carepath Recruitment Ltd is a domiciliary care agency. The agency provides personal care to service users in their own homes. The service supports both children and adults with varying degrees of support needs. The agency is located in the town centre area of Preston, close to the town’s bus station. The office space is shared with the other part of the business which is a recruitment agency.

At the time of the inspection there were nine service users receiving support from Carepath Recruitment: four children and five adults. Following the last inspection a voluntary agreement had been made between the provider and CQC to not agree any further packages. It was discovered whilst planning for this inspection, that the provider was supporting three more service users than declared at the last inspection and had agreed a further two since the last inspection. The provider had been asked directly via email the service users they were supporting and again did not declare all of the packages.

On the day of the inspection the provider, who is also the registered manager was not available to assist the inspection team. The provider had recruited a care coordinator who was available to the inspectors. We asked the care coordinator who Carepath recruitment were providing support too and again not all the packages were declared. It was only when names were given to the care coordinator it was confirmed the service users were being supported. When we discussed this with the provider and registered manager, we were told, it was a mistake and they thought the commission meant for them to only declare the services the commission were aware of. Following this inspection an urgent Notice of Decision was served onto the provider to ensue no further packages of care were agreed and that the current packages did not increase in hours.

The service was last inspected in August 2016 where six breaches of the regulations were found. The home was rated as inadequate overall and placed into special measures. The key questions of safe, effective and well led were previously rated as inadequate, responsive and caring were rated as requires improvement. At this inspection we found the quality of provision had further declined and the key question of responsive was now also rated as inadequate, with caring remaining as requiring improvement. At this inspection we saw some improvements had been made to some of the regulations and one breach to Regulation 10 was now met. However we noted continued breaches to five of the regulations and breaches to four further regulations. We also judged the provider to be in breach of one of the registration regulations.

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 had legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of this and the previous inspection the registered manager was also the sole director for the registered provider.

At this inspection we found some improvements had been made to some areas, namely at the last inspection there were no care plans for some service users in receipt of support. We found care plans had recently been completed for all service users being supported but we were concerned about the quality of those care plans. At the last inspection staff told us, they did not receive support or supervision. It was clear the new care coordinator had begun to undertake supervisions with some of the staff. When we spoke with staff we were told these were arranged when there was an issue or when they went into the office, time would sometimes be taken to complete supervision. We could not see a definitive timescale for the expectation of supervision but they had begun which was an improvement from the last inspection.

At the previous inspection we found that service users were not involved with the development of their care plans and did not influence the support they received. At this inspection we found that review meetings had begun and they included any concerns the family or service user had shared with the provider. However they were not structured and had only begun in the last month prior to the inspection so the impact of these could not be seen. We did not note any changes to service user’s care plans as a result of the reviews.

As at the last inspection we found risks and service user’s support needs were not always assessed appropriately. We found the same at this inspection. Medication risk assessments were simply a list of the medications rather than an assessment of the risks associated with the person taking or not taking the medication. There was no person centre information in the assessments to determine any risks with any aspect of service user’s medication. We found other risks which were identified within initial assessments or daily records were not assessed and plans of care were not developed to support service users with their specific needs.

Medication was again poorly managed and various gaps in the MARs (Medication Administration Records) were evident. These were not picked up via audits and the reason for the gaps was not explored. This could have meant service users had missed their medication.

At this inspection we visited the property of one of the children in receipt of support and three of the adult packages. In all the homes we visited we found contradictory information within the care plan held in the office and the one held in the home. Service users were not protected by up to date, appropriate and reflective care plans and assessments.

We found other areas of service delivery had not changed since the last inspection including poor audits of the service provided and a lack of collation of accidents and incidents to identify themes and trends. This would enable the service to reduce any identified associated risks.

There was not any evidence at this or the previous inspection to support the implementation of the Mental Capacity Act 2005. We were aware of service users who were restricted in their daily activity and applications had not been made to the court of protection to ensure this was done legally. We were also aware of service users who did not have the capacity to make informed decisions or give consent and the service had not assessed how to best support these service users.

We found staff had not all received appropriate training for the role they were undertaking. Supervision had recently begun, but there were no systems in place to test the competency of the staff. This was in respect of their duties including moving and handling, medication administration and the management of more complex needs. We had concerns in all three of these areas.

Staff were not recruited safely. Whilst we saw appropriate checks via the DBS, we noted references were not validated and some application forms held miss information that was not identified and assessed, to determine staff suitability to their role.

We were told by staff that things had recently improved and whilst the care coordinator told us some staff were now on permanent contracts, in the five files we reviewed all staff remained on zero hours contracts. Service users we spoke with, spoke well of the staff and staff we spoke with appeared motivated to complete their role as well as they could.

We discussed at length the requirements of the regulations and the need for robust systems of quality audit to drive improvement. At the last inspection concerns were noted and the provider was informed of what was required to address the issues. The provider had developed action plans for the breaches noted within the report. Areas of a higher concern had been detailed within other correspondence to ensure the provider made improvements with the service. We found the provider had not taken the steps, they had identified as required within the action plans, presented to the commission to address the identified breaches. This included the completion of capacity assessments for all service users using the service, supervision of staff who had made errors on medication records and staff administering medication to have their competence checked. Omissions also included; the inclusion of family and service users using the service in development and review of care packages and that service users could choose their care worker. No one we spoke with confirmed that this happened.

We found steps had been taken to better support one person in a more dignified and respectful way, but we still had concerns about the management of this package. A robust system of quality audit had not been developed or implemented. Without this it is clear improvements could not be measured by the provider. We continued to find the leadership of the organisation was not engaged with the delivery of registered activities and the regulations that underpin them.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were namely around; safe care and treatment, need for consent, good governance, person-centred care and staffing. We also found additional breaches in respect of managing complaints, safeguarding, the recruitment of staff and a failure to display the last inspection ratings. Breaches to the registration regulations were also noted in respect of the submission of notifications.

The overall rating for this provider remains ‘Inadequate’. This means that it will remain in ‘Special measures’ by CQC.

Carepath Recruitment Ltd is a domiciliary care agency, which provides personal care to both children and adults in their own homes. The service is available to people of all ages, with support needs ranging from mild to moderate, to complex and profound support needs. The agency is situated in the town centre area of Preston. The agency, although having a separate office, shares office space with the company's staff recruitment business.

The service is registered to provide personal care, on the day of our inspection there were 5 people using the service.

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.

We looked at how the service protected people from avoidable harm. We found that risk assessments were not always up to date. Where risks had been identified, care planning around the associated risk was not recorded. In some examples, no action had been taken to manage the risks, which meant people had not been protected by the service. The availability of parents and relatives meant that people’s safety was protected.

Accidents and incidents were not held centrally and therefore we could see no evidence that they were analysed to identify patterns and learn from them.

We asked staff if they felt there were sufficient numbers of care workers to provide care and support for people and found that this was not always the case.

We looked at people’s care plans at this inspection and found gaps in information regarding people’s medicine regimes.

We checked how staff had been recruited we saw records which showed the provider had undertaken checks to ensure staff had the required knowledge and skills, and were of good character before they were employed at the service. Staff told us they knew how to report safeguarding concerns and felt confident in doing so.

We looked at how the service gained people’s consent to care and treatment in line with the MCA. We found that the principles of the MCA were not consistently embedded in practice.

We found staff were not being supported by way of regular and effective supervision and appraisals. We found that staffing had not always received adequate training to care for the people they support.

We received some positive comments about the staff and about the care that people received. Care plans for adults were of very poor quality and did not have enough detail considering the complex needs of the adults cared for. We observed staff providing support for one person and the staff member approached the person in a caring, kind and friendly manner.

We checked whether the service was well led. Evidence we found showed there was a lack of management oversight and leadership for care staff. We found the service had no clear lines of responsibility and accountability. We found leadership of the organisation was not engaged with the delivery of registered activities. We found that the service did not have a robust quality auditing system in place, and no checks were completed for care staff.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care and treatment, need for consent, good governance, dignity and respect, person-centred care and staffing.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Following the inspection in April 2017, the provider was issued with an enforcement notice, to restrict the service in supporting any new packages of care or increasing the hours of current people who use service’s care packages. Prior to this inspection we understood the provider was supporting five people. During the inspection, information the commission had received, was confirmed and it was found the service were supporting six people We also found the provider had increased the hours of two care packages in contradiction of the notice issued following the last inspection.

At the last inspection in April 2017 there were 14 breaches identified to nine of the regulations. The provider should have submitted an action plan to the commission identifying how they intended to meet the requirements of the regulations for which a requirement notice was given. This had not been sent. This was requested again at this inspection but had not arrived to date of writing this report.

Following the last inspection, we asked the provider to complete a weekly action plan from the audits and risk assessments completed at the service. The action plan was to show us how the service intended to improve and meet the requirements of the regulations.

There was an initial delay whilst the provider recruited a suitably qualified individual to complete the action plan and audits. We had received four submissions prior to this inspection. The submissions were poor and did not identify the action the provider would take to meet the requirements of the regulations. The commission has supported the provider to better develop the action plans and weekly submissions have been received following this inspection and up to the date of writing this report. However, the action plans fall short of addressing the concerns noted within the previous inspection report and do not directly address the breaches to the regulations.

Since the last inspection our methodology and Key Lines of Enquiry have been updated under the new assessment framework October 2017. We described these changes to the provider at the start of the inspection.

None of the identified breaches from the last inspection have moved to a different key question. However, we now have more focused lines of enquiry for partnership working and working across organisations to provide person centred care. This has led to breaches in more than one key question for this area.

This service is 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 adults, younger disabled adults and disabled children.

This service is required to have a registered manager under the current regulations. 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.

The registered manager for Carepath recruitment is also the sole director for the provider. The provider has no other registered services.

Since the last inspection the provider was asked to recruit a suitably qualified person to support the office management and delivery of the regulated activity. This service provides the regulated activity personal care. We found that the recruitment to this role has led to some improvements in how the service addresses concerns. However, the changes have not gone far enough to sustain improvements and meet the requirements of the regulations. At this inspection we were informed of a package of care that was previously undeclared. The service has not been equipped to support this person. The poor support provided to this person has reinforced previous breaches and led to further breaches being identified.

At this inspection we found the service had again breached 10 of the regulations but three of the regulations namely regulation 9 around person centred care, Regulation 12 around safe care and treatment and regulation 17 around good governance have each been breached five times. This meant at this inspection we found the provider had breached the regulations 22 times. This was primarily as a consequence of the poor care provided to the package previously undeclared.

The impact of the breaches identified has been replicated in the support provided to other people who use the service but fortunately other people who use the service had greater support networks and required less support from the provider.

Since the last inspection we found the provider had developed a generic risk assessment which identified if a further risk assessment was required for moving and handling, medication or capacity. We found that each of the risk assessments was focused more on the risk to staff than on the risks to the people who use services. The capacity assessment had not been completed for any person using the service and the assessment was not seen. We also found the other assessments had not been completed in a way to ensure risks could be appropriately identified.

We found the provider has not effectively assessed the risk of people’s health and safety through the poor assessment of action required in the event of a major incident and the impact of equipment not being professionally tested.

We again found staff at the service have been poorly recruited and are not suitably trained to complete the role they are employed to undertake. We have also found staff are not suitably trained or receive appropriate competency testing to perform clinical tasks including administering medication and supporting people with a PEG (Percutaneous endoscopic gastrostomy). This is a tube that goes directly into a person’s stomach to allow nutrition, hydration and medicines to bypass the throat.

We found the service in continued breach of the regulation associated with the safe management of medicines and found the audit of both medicines and other service provision not to be adequate.

We found when the service identifies concerns they are not acted upon appropriately.

People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

We found that the people using the service have not given formal or appropriate consent for the service they receive. This is especially prevalent when people lack capacity. No capacity assessments have been completed and there are no records to show decisions made for those lacking capacity have been made in their best interest or is the least restrictive option.

We have breached the service for the poor support provided to ensure people received enough nutrition and hydration.

Records the service completes for the delivery of the regulated activity are not appropriate. The service continues to record information that is incomplete, inconsistent and in unsuitable formats. This does not allow for the safe and consistent delivery of care, the accuracy of monitoring records do not identify concerns which in turn do not lead to the improvements required.

We found the provider had not provided enough guidance to staff on how to safeguard the people they support. This included restrictive practice that was not appropriately assessed and alerts not being made to the Local Authority or CQC. At the time of the inspection only three staff had received safeguarding training in the last 12 months.

The service was not delivering commissioned activities to one person who was completely dependent on the service for their social and emotional support.

The provider and service were not working with other professionals in the delivery of specialised care. Records and support tools that should be used to support people with complex needs were not used.

The provider had not displayed the ratings for the last two inspections. The provider had also recorded on their website that they were meeting the necessary standards. The service also advertised to support people who were the most vulnerable. We had asked the provider to remove this information and they had not at the time of writing this report.

The provider had misled the commission at the two previous inspections and not declared the most complex package they were supporting. They had also not acted in accordance of a formal notice from the commission and increased the hours of two packages of care.

We have made 10 recommendations. Recommendations are made around introducing exit strategies for the ever changing work force. At both this and the last inspection we were told all staff were new to post. However, the records and the staff we spoke with did not support this assumption.

We made two recommendations around the update of specific policies namely end of life and complaints. We have also included the outdated policies as part of a breach to regulation 17 which has also included the implementation of up to date best practice guidance.

We made further recommendations about sharing information with people who use services of the available support networks, specifically for those people living with learning disabilities. We have recommended that personalised care delivered, is included formally in care plans and that involvement of people who use services or their appointed representatives is formalised in care planning.

We have recommended the provider ensures information is available around how they are supporting people with protected characteristics under the equalities a

When we spoke with people who received the support that Carepath Recruitment Ltd provided they told us that overall they were satisfied with the service offered. Families reported that the staff were friendly, reliable and always tried their best to help out. People said things like, "I'm very happy with my care worker" and "The carer is brilliant, she is flexible and fits in with us" and "She is prompt, never lets us down and takes a real pride in her work." 'The staff help me to carry on with my family life".

They told us that they knew who to contact at the office if they did have any concerns or problems and always had a positive response. Some families told us that while they were very happy with their care worker they were concerned about cover for holidays and sick leave and had experienced occasional problems with getting cover. The provider had recently recruited more staff to help with this.

Families were involved in the development of care and support plans. We saw that records for the safe running of an agency were in place and up to date.

People who used this service were protected from the risk of abuse, because the provider had ensured that staff were trained and knew the local children and adult safeguarding procedures.

“The service we receive is brilliant. I have never had any issues about anything. The staff are reliable, well trained and competent. The care my daughter is receiving is second to none”.

“We always have the same group of staff. They are really caring and compassionate people. I have no concerns about my daughters care”.