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CRG Homecare Lincolnshire Requires improvement

We are carrying out a review of quality at CRG Homecare Lincolnshire. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 26 May 2021

During a routine inspection

About the service

CRG Homecare Lincolnshire provides personal care to people living in their own home. The service was providing support for approximately 250 people living in and around Boston and Sleaford in Lincolnshire. Some of the people were living in two extra care housing apartment complexes one in Boston and one in Sleaford.

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 received a different level of service dependant on where they lived, with people living in and around Sleaford being mainly happy with the care provided. However, people in the Boston area received a poor quality of care. There were not enough staff to meet people’s needs and call times were inconsistent and not in line with people’s wishes. People’s choices over gender of staff were not always supported.

The provider’s systems to monitor, and drive improvements in the quality of care were ineffective. Lessons were not being learnt when incidents happened, or complaints were received. Communication with people using the service and relatives was inconsistent.

People received care from multiple members of staff and felt this impacted on their care as they were unable to develop trusting relationships with staff. Where people did get to know staff, they felt that staff were caring. Medicines were not always safely managed. Specific guidance on the safe administration of medicines was not always followed. Appropriate checks were completed before staff began work at the service.

Staff training had not been kept up to date and staff had not always been supported with spot checks and one to one supervision with their manager. People’s care plans were not always developed in a timely fashion and had not been reviewed on a regular basis in line with the provider’s policy. People were not always able to eat at a time which suited them due to inconsistent call times. Staff raised concerns to healthcare professionals when people were unwell.

People were not supported to have maximum choice and control of their lives. However, staff did support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not always support this practice. This was because people did not always receive their care at a time of their choice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 January 2021) and there were multiple breaches of regulation. A warning notice was issued telling the provider they needed to improve their service. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to there not being enough staff to meet people’s needs at the time they requested. That risks around the administration of medicines were safely managed and the systems in place to manage the service were ineffective.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representati

Inspection carried out on 9 November 2020

During an inspection looking at part of the service

About the service:

CRG Homecare Lincolnshire is a domiciliary care agency. It provides personal care to people living in their own homes in the community and two specialist housing schemes. The service operates in and around the towns of Boston and Sleaford in Lincolnshire.

Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of our inspection, approximately 300 people were receiving a personal care service.

People’s experience of using this service and what we found:

The provider had failed to ensure there were sufficient staff deployed in the Boston area of operation, increasing risks to people’s safety and welfare.

Staff did not always comply with the requirement to wear personal protective equipment (PPE), increasing the risk of COVID-19 spreading within the service. The management of people's medicines was not always safe.

The provider had failed to effectively assess, monitor and improve the quality of the service. Notifications about events that had happened in the service had not been submitted to CQC, as required in law.

More positively, staff were generally satisfied with their experience of working in the service. Most people and their relatives also provided positive feedback on the caring, friendly nature of staff.

Staff worked collaboratively with local health and social care services. Staff knew how to recognise and report any concerns to keep people safe from harm. People’s individual risk assessments were reviewed regularly.

There was organisational learning from significant events and staff recruitment was safe.

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 19 June 2019).

Why we inspected:

We received concerns about the safety of care delivery and organisational governance. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No significant issues 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.

Enforcement:

At this inspection we have identified breaches of regulations in relation to staffing; the assessment of risks to people's safety; monitoring service quality and notification of significant events. For each of these breaches you can see what action we have asked the provider to take at the end the full version of this report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 4 March 2019

During a routine inspection

About the service:

CRG Homecare Lincolnshire is a domiciliary care agency providing care to people in their own homes. It was providing personal care to 249 people at the time of the inspection.

People’s experience of using this service:

Most people told us they were happy with the service they received. Some people raised concerns about the timing of visits and the continuity of staff. The registered manager and provider had already identified these areas of concern and had taken action to improve the quality of care provided to people.

There were enough staff available to meet people’s needs and the provider continued to recruit staff to ensure they maintained staffing at an appropriate level. Staff received training and support to ensure they provided safe care to people. The provider had systems in place to ensure best practice guidance was shared with staff. Safe recruitment practices were followed.

Risks to people had been identified and care was planned to keep people safe. Where needed equipment was available and staff had received training in how to use it safely. Staff had received training in infection control and knew how to minimise the risk of spreading germs. Medicines were safely managed. People’s ability to eat and drink safely had been assessed and where necessary people had been referred to healthcare professionals.

People’s care plans reflected the care they needed and people had been involved in planning and reviewing their care. People’s ability to make decisions for themselves were assessed and where needed family and healthcare professionals were involved in making decisions in their best interest.

Formal complaints were dealt with effectively, however people told us issues raised informally were often not resolved and the provider did not contact them to discuss their concerns.

We have made a recommendation about the management of complaints.

There were effective systems in place to monitor the quality of care provided and they had already identified the concerns raised around call times and consistency of staff.

Rating at last inspection:

The service has not previously been rated.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about this service until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk