21 August 2019
During a routine inspection
Pegail Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, including people living with dementia, and younger disabled adults. 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 was supporting nine people with personal care at the time of the inspection. During the inspection process, the service voluntarily ceased operations and went into insolvency (the provider was unable to pay the money they owed) and people receiving care from Pegail Ltd were supported to start receiving care from other care providers. While the service stopped providing a service during the inspection process, the provider has not applied to remove the location from their CQC registration.
People’s experience of using this service and what we found:
The service was not safe. On the 31 July 2019, a number of staff members went on strike and later left the company. This placed people at risk as the provider was unable to cover care calls and had to receive support from the local authority. Staff members were also deployed from the provider’s care service in Essex. However, this meant that people had been receiving care from staff members who were unfamiliar with their needs.
The provider was not open and honest with people, relatives and healthcare professionals about the difficulties they were facing with staffing. People and their relatives fed-back that they found it difficult to get hold of the provider or office staff. Health care professionals also raised concerns around lack of communication from the provider. Where people experienced missed or late calls, the provider had failed to follow the Duty of Candour principles (principles requiring providers to act in an open and honest way) and people experienced poor provision of care.
Staff had not been recruited safely. People had been receiving care from staff members without appropriate checks in place or from staff members who had positive convictions. The management of risk was inadequate, and people had been receiving care from an unreliable service. People told us how staff members often rushed them, ran late and didn’t stay for the allocated time.
People and their relatives told us of their worries that staff would not turn up for the next care call and people confirmed that they would not recommend the service. The management of medicines was not safe, and the provider was unable to demonstrate that people received their medicines as prescribed.
The scheduling of care calls was poor and staff members did not receive travelling time between care calls. People did not receive a weekly rota advising them of who would be arriving and at what time to deliver their care. People and their relatives told us that care staff often arrived with no ID badge and without wearing a uniform. People received care from unfamiliar staff and this made them feel uncomfortable within their own home.
The provider was unable to demonstrate that staff had received adequate training to meet the needs of people. People and their relatives raised concerns around the competency and skill set of staff members.
It was difficult to establish whether the provider had a governance framework in place. Several documents such as complaints and incident and accidents could not be reviewed during the first day of the inspection. These were subsequently requested from the provider but were not provided before the service ceased operations.
People were not consistently supported to have maximum choice and control of their lives as they were unsure of when care staff would be arriving, and this limited their ability to live their daily life.
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 (report published 16 April 2019) and the provider was found to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider remained in breach of regulations.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement:
We have identified breaches in relation to Regulation 9 (Person Centred Care), Regulation 10 (Dignity and Respect), Regulation 12 (Safe Care and Treatment), Regulation 17 (Good Governance), Regulation 18 (Staffing), Regulation 19 (Fit and Proper Persons Employed), Regulation 20 (Duty of Candour) and Regulation 18 Registration Regulations 2009 (Notifications of other incidents).
Full information about the Care Quality Commission's (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.
Follow up:
The service voluntarily stopped operating during the inspection process as the provider went into insolvency. However, the provider has not applied to remove the location from their registration. We will continue to monitor information we receive about the service. 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.