Background to this inspection
Updated
10 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. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
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 or registered manager would be in the office to support the inspection.
Inspection activity started on 11 March 2020 and ended on 13 March 2020. We visited the office location on 11 March 2020 and made calls to people supported by the service, their relatives and staff on 12 and 13 March 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We also sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service and three relatives about their experience of the care provided. We spoke with six members of staff including care workers and the registered manager. We reviewed a range of records. This included seven people’s care records and multiple medication 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 policies and procedures were reviewed.
Updated
10 April 2020
About the service
Absolute Dignity Care Ltd is a domiciliary care agency providing personal care. At the time of our inspection, the agency was supporting 11 people.
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 were at risk of harm as risks were not consistently assessed or mitigated. Systems to protect people from abuse and improper treatment were not effective. Opportunities to learn from adverse incidents had been missed which meant action was not taken to prevent reoccurrence and keep people safe. There was a risk medicines may not be managed safely. People were exposed to the risk of infection. There were not enough staff employed to ensure people’s safety and meet their needs and safe recruitment practices were not always followed.
Staff did not have adequate training to provide safe and effective care and support. Issues with staff performance were not always addressed. Care was not always provided in line with national good practice guidelines and there was a risk people may not receive support to maintain their health.
The service was not well led. Governance systems were limited. Issues found during our inspection had not been identified or addressed. Systems to ensure the safety and quality of the service were not used effectively. The registered manager had not addressed known issues and there had been a failure to make improvements in relation to issues found at our previous inspection. People, their relatives and staff had opportunities to provide feedback and shape the development of the service and the provider understood their responsibilities to be open and honest when things went wrong.
Systems did not ensure people’s right to privacy was upheld, as steps had not been taken to protect their personal information. There was a risk people may not receive consistent, personalised support. People coming towards the end of their lives had not been given opportunity to think about and plan for their final weeks and days.
People were supported by staff who were kind and caring and they were involved in decisions about their care and support. People were supported to be as independent as possible. 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 had enough to eat and drink.
Where possible, staff supported people to connect with people who were important to them and their local community. People’s complaints and concerns were addressed, however, record keeping in this area was poor.
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 requires improvement (published 5 March 2019).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to safeguarding, safe care and treatment, staffing levels and staff training, person centred care and governance.
Please see the action we have told the provider to take at the end of this report. 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 continue to monitor information we receive about the service and 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.
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. Aand it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.