Background to this inspection
Updated
24 April 2020
The inspection
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.
Inspection team
The inspection was carried out by one inspector.
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 had a manager registered with the Care Quality Commission. The registered manager was also the provider. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.
This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider would be in the office to support the inspection.
Inspection activity started on 04 December 2019 and ended on 12 December 2019. We visited the office location on 04 December 2019.
What we did before the inspection
The provider had completed 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 reviewed the information we held about the service.
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 had not been to the service and had not received any information about the service. We received feedback from a local authority quality assurance worker, who told us they did not have any involvement with the service at the current time. We used all of this information to plan our inspection.
During the inspection
We spoke with one people who used the service, one friend and one relative about their experience of the care provided. We spoke with three staff including the provider.
We reviewed a range of records. This included one person's care records and medicines records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data, further recruitment records and policies and procedures.
Updated
24 April 2020
About the service
Green Leaf 24Hr Care Services is a domiciliary care service providing personal care to people living in their own homes. 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. The service provided care and support to older people. The service was providing personal care to one person at the time of the inspection.
People’s experience of using this service and what we found
The provider did not have effective safeguarding systems in place to protect people from the risk of abuse. Staff did not have confidence in the provider to appropriately deal with concerns if they reported them. However, staff knew where they could go outside of the organisation to raise concerns if necessary.
The provider had not always assessed and managed risks to people's safety. Staff reported that there were no risk assessments within the person’s home and they had not received any guidance and support from the provider to meet people’s needs safely. The provider did not have a system in place to monitor accidents and incidents. There was no learning from accidents and incidents to reduce the risks of issues occurring again. Accidents and incidents had occurred which the provider was unaware of.
Staff were not recruited safely. The provider had not carried out any employment checks for one staff member who was working for the service. Recruitment records for other staff had been falsified. Staff had not received any training, induction or support. Staff had not received supervision to gain feedback on their performance, identify training needs and discuss any concerns.
Medicines are not well managed. Staff have not had medicines training. The provider had not assessed staff competency to check they were giving medicines safely. Medicines administration records did not list all prescribed medicines the person was taking. Medicines records had gaps.
The provider had not ensured people were protected by the prevention and control of infection. Staff had run out of personal protective equipment (PPE) to help them carry out their role safely to help prevent the spread of healthcare-related infections.
Prior to people receiving a service their needs were assessed. The person receiving care had been assessed the day before they started to receive a service in September 2018. The assessment for the person had not been reviewed and updated since September 2018. Although the provider had put a care plan in place following the assessment of the person’s needs, the care plan had not been placed in the person’s home. This meant that staff working with the person did not have all the information they needed to provide the person the care that they needed.
Quality monitoring processes were poor and did not provide the information the provider would need to be assured of the quality and safety of the service provided. The provider did not have sufficient oversight of service. The provider had not completed audits or checks to make sure the service being delivered was safe and effective.
The provider had no oversight about people’s health needs and how staff were meeting these. People's health and medical conditions were included in their care plans which were kept in the office. The staff did not have access to the information. They were not aware of people’s health conditions and what signs to look for if their health was becoming unstable and when to seek medical support. .
The provider had not effectively logged or handled complaints according to their policy. The complaints policy did not have all the information people needed to escalate concerns if they were not happy with the response from the provider. We made a recommendation about this.
People told us they were well treated, and staff were kind and caring towards them. People were treated with dignity and respect by staff. However, the provider had not treated people with dignity and respect and had not treated people in a caring manner through the failure to provide safe, effective, responsive and well-led care.
People received support to prepare and cook meals and drinks to meet their nutritional and hydration needs. People directed their own care. Staff encouraged and supported people to maintain their independence.
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 had control of their lives and made choices and decisions. People’s communication needs were met.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 17 October 2017 and this is the first inspection. The service was not providing any personal care until September 2018.
Why we inspected
This was a planned inspection based on our current inspection programme.
Enforcement
We have identified breaches in relation to medicines management, risk management, infection control, safe recruitment, keeping people safe from abuse, training and support for staff, failure to assess and plan care to meet people’s needs and failure to put in place systems to monitor and improve the service.
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 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.