Archived: CRG Homecare Stockton

Updated 26 June 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team: The inspection team consisted of two inspectors.

Service and service type: CRG Homecare Stockton is a domiciliary care agency and provides personal care and support to people living in their own homes. The service also provides care and support to people living in specialist ‘extra care’ housing in Stockton-On-Tees and in four supported living settings. The extra care housing was a purpose-built set of flats and a bungalow on a shared site or building. There is an office on site with concierge staff providing 24-hour cover. Both extra care and supported living accommodation are the occupant’s own home.

People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used in people’s homes or for extra care housing and supported living; this inspection looked at people’s personal care [and support] service.

The service did not have a manager registered with the Care Quality Commission. There have been four managers in post since September 2018, but none have completed the application process to be registered. Having a registered manager 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. It is a breach of the provider’s registration conditions not to have a registered manager.

Notice of inspection: We gave the service 48 hours’ notice of the inspection site visit because we needed to be sure people using the service and the registered manager would be able to speak with us.

The inspection site visit started on 1 April 2019 when we visited the office to see the manager and office staff. We visited the office on 9, 18 and 29 April 2019, to follow up on concerns we had found. We asked staff to let people and their relatives know we hoped to speak with them about their experiences of using the service. The office staff failed to let people know we were inspecting the service.

What we did: Before the inspection we reviewed information, we had received about the service. This included details about any incidents the provider must tell us about, such as any serious injuries to people. The provider completed a provider information return prior to our inspection in September 2018. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We asked the local authority who commissions the service for their views about it. We used this information to plan our inspection.

Prior to the inspection Stockton Local Authority had identified various concerns about the operation of the service and invoked their serious concerns protocol. Inspectors had attended the meetings and were kept informed of any developments.

During the inspection, we visited the extra care housing and met six of the 17 people living there, we contacted 50 people, nine relatives, the manager of Teesside Ability Support Centre or TASC (which is a day service many of the people using the service attend) and social workers. We spoke with both managers, an interim manager, the director of care, quality manager, care planning manager, a team leader, an office administrator and 12 support staff.

We reviewed a range of records. This included six people's care records, medication records and various records related to recruitment, staff training and supervision, and the management of the service.

Updated 26 June 2019

About the service: CRG Homecare Stockton is a domiciliary care agency which provides care and support to people living in Stockton-On-Tees. This service also provides care and support to people living in specialist ‘extra care’ housing and people in supported living accommodation. At the time of the inspection the service provided personal care to for 10 older people and 62 younger adults living with a learning disability.

Following significant concerns raised at the last inspection about the safety of people using the service the provider handed back the care packages for 230 people.

People’s experience of using this service: During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to ensuring the safe care of people, obtaining valid consent, dealing with complaints and effective governance arrangements.

People told us that staffing levels met their needs. However, we found it difficult to establish how the office staff monitored compliance with this, as they did not have accurate information on the care packages being provided. We were told 11 people required personal care but found 36 people were receiving personal care. Local systems to oversee calls were ineffective and staff did not monitor missed, late and unallocated calls.

A manager had started to work at the service a few days before our inspection commenced but left after two weeks and a new acting manager came into post. This lack of oversight and leadership led to most people having problems with staff turning up to provide their support.

We were initially told that everyone had capacity and therefore MCA assessments and 'best interests' decisions were not needed. However, this was incorrect, as some people lacked capacity to make decisions and were subject to Court of Protection deprivation of liberty safeguards. No capacity assessments or best interest decisions were in place for these people to confirm the restrictions that were being imposed.

The provider had been working to improve the risk assessment documentation. Further work was needed to ensure all risks were thoroughly detailed. It was difficult to determine if the care records were truly accurate as staff could not tell us what support people received. When staff supported people with their medicines there was limited independent oversight, as at times staff audited their own work. For some people there was no information was available to support staff should they need to administer as required and emergency medication. This lack of oversight left people at risk in the event of an emergency.

Incident monitoring records were used, and events were reviewed so lessons could be learnt. However, not every incident was recorded. From September 2018 five missed calls were recorded in the incident log however, there had been 165 such events. Safeguarding concerns were not always reported to senior managers or investigated. The lack of accurate information meant the provider was under-estimating problems at the location so had not taken sufficiently robust action to address these concerns.

People were dissatisfied with the way complaints had been managed. The provider was unable to provide us with the outcomes for complaints that had been raised. Everyone we spoke with had raised concerns around the difficulty of being able to contact people in the office. The provider was aware of this issue and was taking steps to rectify this matter.

The staff training, and supervision were being completed but were not fully up to date. The provider had identified gaps in training and put processes in place to rectify this issue.

We found the provider had been committed to making improvements and had developed comprehensive action plans that they were working through. However, we found that these currently had not supported staff to put the basics in place such as understanding the care packages they were to deliver.

People spoke extremely positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. People told us that staff knew them and they generally had the same staff attending calls. Staff knew when to involve healthcare professionals and what action to take in an emergency. Staff assisted some people make their own meals but were led by the person’s choice.

The day after we concluded the inspection the provider handed the care packages back to the local authority.

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

Rating at last inspection: This service was rated as inadequate (Report published October 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The overall rating for the service is inadequate, the service remains in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months to check on improvements.