Background to this inspection
Updated
26 September 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 two inspectors.
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 24 hours’ notice of the inspection. This was because we needed to be sure that the provider would be in the office to support the inspection.
Inspection activity started and ended on 14 October 2019. We also visited the office location on 14 October 2019.
What we did before the inspection
We reviewed information we had received about the service since registration. This included checking for any statutory notifications that the provider had sent to us. A statutory notification is information about important events which the provider is required to send us by law. We had not received any. We contacted the local authority commissioning team for feedback; they told us they did not currently fund anyone who used the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
During the inspection we visited the office location however there was only limited information and records available to review. We spoke with the provider who said they would send us the required information immediately following the inspection visit also spoke with the clinical lead. We requested contact details for people who received a service and for staff members. The provider failed to send them, so we were unable to speak with people and staff about their experiences.
After the inspection
We requested evidence of safe recruitment practices and a list of all staff employed by the provider. We also asked for the induction and training records for each staff member. The provider failed to send this information.
Following the inspection we contacted the Clinical Commissioning Groups (CCG) who were responsible for funding people’s care. They took immediate action to ensure people were safe. The CCG advised the provider had contacted them to request alternative provision be arranged for people, following concerns highlighted at the inspection.
Updated
26 September 2020
About the service
CrucialCare Limited is a domiciliary care service providing personal care to people living in their own homes. 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. At the time of the inspection the service was supporting eight people with a regulated activity. All of the people receiving support were receiving end of life care.
People’s experience of using this service and what we found
People received a service that was not safe, effective, caring, responsive or well-led. The provider, who was also the registered manager was unable to evidence they had established systems to ensure the safe and effective running of the service. Records, which the provider is required to maintain, were of poor quality, inconsistent or unavailable. We were prevented from contacting people or staff for their feedback, as the provider failed to supply contact details as requested.
People were not protected from the risk of harm or abuse as the provider had not ensured staff were trained to identify signs of abuse. Furthermore, the provider was not aware of their responsibilities to protect people from harm and had failed to escalate allegations of abuse with the safeguarding authority. This placed people at risk of future harm.
Due to a lack of available information, the provider was unable to demonstrate people received safe support with their medicines. This placed people at risk of harm. The provider failed to operate safe recruitment practices and as a result people were placed at risk of receiving care from staff who may not be suitable to work with vulnerable people.
Care plans, where available, were inconsistent and did not reflect how changes in people’s needs had been assessed, recorded or shared with staff. Due to the lack of records, we were unable to confirm if people’s risks had been assessed. Care plans lacked clear guidance and information for staff which placed people at risk of receiving unsafe care.
The provider was unable to demonstrate staff had received training relevant to their role. They had not assessed the competency of staff in their employment, so could not assure themselves staff were fit to provide care and support.
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.
All of the people receiving support were at the end of their lives. However, care plans did not contain details of people’s end of life wishes. The provider had also failed to ensure staff were trained to deliver end of life care to people. A lack of available information and the absence of contemporaneous records and care plans meant we were unable to assure ourselves people received care that was dignified and person centred.
The service was not well-led. The provider had failed to establish systems to ensure effective oversight of the service and were unable to evidence they had sought feedback from people and staff. The provider had also failed to notify relevant agencies about safeguarding concerns and had failed to submit notifications to CQC as required by law.
Information requested during and following the inspection was not provided.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 12 November 2018 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about unsafe recruitment practices. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive 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.
Enforcement
We have identified breaches in relation to safe recruitment of staff, safe care and treatment, safeguarding people from abuse and the governance of the service at this inspection.
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 until we 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. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.