Archived: Leader Care

Updated 24 June 2021

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 conducted by two inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

The service did not have a manager registered with the Care Quality Commission at the time of inspection in line with the requirements of the provider's registration. The provider had recruited a manager who resigned during the inspection but then rescinded their notice and returned to post. This means that the nominated individual is legally responsible for how the service is run and for the quality and safety of the care provided. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

This inspection was unannounced. Inspection activity started on 26 April 2021 and ended on 28 May 2021. We visited the office location on 28 May 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. 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

We spoke by telephone with one person who used the service, one relative and one health professional about their experience of the care provided. We spoke with four staff by telephone. We spoke with the manager, and the nominated individual by telephone and during the site visit. We reviewed a range of records, this included three people's care records. We looked at three staff files in relation to recruitment and training. A variety of records relating to the management of the service, including policies and procedures were also reviewed. We liaised with the local authority when we had concerns we needed to share with them to ensure people’s safety.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 24 June 2021

About the service

Leader Care is a domiciliary care service. It is registered to provide personal care to people living in their own homes in the community.

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, three people were receiving a personal care service.

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

The provider was failing to effectively assess, monitor and improve the quality and safety of the service and to assess and manage a range of potential risks to people's safety and welfare. The leadership, management and governance arrangements did not provide assurance the service was well-led. Quality assurance and governance arrangements had not been reliable or effective in identifying shortfalls in the service.

Information relating to people's individual risks were not always recorded or mitigated and did not provide enough assurance that people were safe. Suitable arrangements were not in place to always ensure the safe management of medicines and this placed people at risk of harm.

Lessons were not consistently learned to improve the quality of care for people using the service. The provider's response to the COVID-19 pandemic was inconsistent and increased risks to people's health. Appropriate measures were not in place to prevent and control the spread of infection.

Recruitment procedures were not always robust enough to ensure suitable people were employed. Staffing levels were maintained. However, changes to calls were made without discussion with people and there was no analysis of missed or late calls to prevent them happening again.

A person and a relative we spoke with were satisfied with the care and support they or their family member received from individual staff. They described staff as kind and caring. However, they said arrangements to communicate with them were not effective; for example, they did not know which staff were coming to provide their care. Care plans covered people's individual care and support needs. Improvements were still required to ensure each person's care plan was up to date and accurate.

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 Inadequate (published 17 December 2020) and there were multiple breaches of regulation. The provider told us after the last inspection what they would do to improve. At this inspection we found insufficient improvement had been made and the provider was still in breach of regulations.

Why we inspected:

This was a planned inspection due to an increasing number of concerns being raised with us about the safety, management and leadership of the service and to follow up on action we told the provider to take at the last inspection. The inspection was focused on the key questions of Safe and Well-led. We reviewed the information we held about the service. No areas 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Leader Care on our website at www.cqc.org.uk.

The overall rating for the service remains Inadequate. This is based on the findings at this 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 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.

At this inspection we have identified continued breaches of regulations in relation to the assessment and management of potential risks to people's safety; medicines management; infection prevention and control; recruitment; staffing; governance and leadership of the service.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the registered person's registration, we will re-inspect within 6 months to check for significant improvements.

If the registered person 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 registered person from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of 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 re-inspect it and is no longer rated as Inadequate for any of the five key questions, it will no longer be in special measures.