About the service Charity Earnshaw is a domiciliary care service, supporting adults in the community who require assistance with personal care. This included people living with dementia, physical disabilities, mental health needs and sensory impairments. At the time of our inspection there were 24 people who used the service supported by 14 staff.
People’s experience of using this service and what we found.
Prior to our inspection we found peoples experience of the service was poor and made a number of safeguarding referrals. A whole service safeguarding enquiry was in progress with the local authority. A suspension of local authority placements was in place, and a voluntary suspension of new private placements.
Risks were not well managed. Risk assessments did not consistently provide the information staff needed to understand and minimise risks. There were no systems in place to ensure people would not be placed at risk if there were any problems affecting service provision, such as Covid-19, staff sickness or adverse weather conditions.
Concerns about people’s health and safety had not always been escalated by staff, and not all staff we spoke with were aware of the processes for doing so. External health professionals and relatives told us the provider did not always work effectively with other agencies to provide safe and effective care. Safeguarding concerns had not always been managed appropriately and had not been reported to the local authority or the Care Quality Commission. Safeguarding policies and procedures were out of date.
The administration of medicines was not safe because staff had not always had the necessary training or their competency checked. There were no processes in place to audit the safety of medicines administration. This meant medication errors had not always been identified or reported to safeguarding as required.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Staff had not received the induction, training and support required to develop and maintain their professional skills. Not all staff, including the provider, had completed training in infection control, and there had been a significant delay before staff received specific Covid 19 infection control training. The provider had not maintained their knowledge and skills or kept themselves up to date with best practice guidance. This meant they were unable to ensure care delivered by their staff group was in line with good practice standards, guidance and the law.
The provider did not have adequate systems in place to monitor and review the quality of care and ensure the service was meeting people's needs safely and effectively. Policies and procedures were out of date and not always relevant to the type of service being provided. They were not always well understood and followed by staff.
The service had expanded significantly since the last inspection. When we inspected in June 2019, 18 people were being supported. By August 2020 this had increased to 33 people. The staff team had increased from five to 14. The provider told us the training and development of the staff team and service had been delayed as a result of the pandemic and lock down.
The provider and staff team were committed to improving the quality and safety of the service. One member of staff told us, “A lot of things need to be updated. I know the provider is doing their utmost to get everything in place. I’m happy now it’s being put in place. It’s improving.”
The provider was working with the local authority quality assurance and improvement team (QAIT) to identify and make the necessary improvements. They had drawn up a service improvement plan. This identified the actions needed, who was responsible for them and the progress being made. New policies and procedures were being introduced and quality assurance tools developed.
Staff were in the process of completing relevant training. Spot checks and staff supervisions had recently begun. Risk assessments, care plans and mental capacity act assessments were being reviewed by the newly recruited senior carer.
Overall people spoke positively about the service. However, although there were some recent improvements in the way the service was managed and run, these were not effective or embedded.
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 11 July 2019)
Why we inspected:
We undertook this targeted inspection to follow up on specific concerns we had received about the safety and quality of the service. These concerns were subject to individual and whole service safeguarding investigations. A decision was made for us to inspect and focus on the management of risk, staff training, medicines administration and quality assurance. During the inspection, we found additional concerns related to protecting people’s human rights; the management of safeguarding and the knowledge and skills of the provider. We therefore widened the scope to become a focused inspection which included the key questions of Safe, Effective and Well-led.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charity Earnshaw on our website at www.cqc.org.uk.
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We found the issues identified were not caused by the pandemic.
We identified five breaches in relation to risk management; the administration of medicines; staff training and support; consent; working with other agencies; notifications and overall governance.
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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.