Background to this inspection
Updated
22 November 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. 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 and an Expert by Experience. An Expert by Experience (EXE) is a person who has personal experience of using or caring for someone who uses this type of care service. They made telephone calls to discuss people’s experiences of the care and support received.
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 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection site visit activity started on 30 September 2019 and ended on 2 October 2019. We visited the office location on 30 September and 2 October 2019 to see the registered manager and office staff; to review care records and policies and procedures. The EXE made telephone calls to people on 27 September and 30 September 2019.
What we did before inspection
We reviewed information we had received about the service since the last inspection. 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.
During the inspection
Throughout the inspection we gave the registered manager opportunities to tell us what improvements they had made since our last visit.
We conducted two home visits and spoke with three people about their experience of the care provided. We spoke with six relatives on the telephone, two care staff, an office administrator, the care co-ordinator and the registered manager. We viewed nine plans of care, three staff files in relation to recruitment, two medicine administration records, induction and supervision records, training data, policies and procedures and a variety of records relating to the management of the service.
Updated
22 November 2019
About the service:
Precious Care Services Ltd is a domiciliary care agency that provides personal care to people living in their own homes. At the time of our inspection the service was supporting 12 people.
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.
People’s experience of using this service and what we found:
Systems in place to protect people from abuse were not effective. Staff were not able to demonstrate good knowledge of how to protect people from harm despite attending relevant training. The service did not ensure staff had access to current guidance about raising and responding to abuse.
People were at risk of harm because management plans put in place to mitigate risks to their welfare and safety, were not fit for purpose. Staff who carried out practical care tasks such as, using equipment to move people and administering of medicines, did so without receiving appropriate training. Unsafe recruitment practices meant the service did not make sure people received care from staff who were not suitable. The service failed to follow national guidance and best practice regarding medicine management. This resulted in unsafe and poor practices which placed people at risk of potential harm.
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; as the policies and systems in the service did not support this practice.
The service failed to ensure the delivery of care was personalised to meet people’s specific needs. Reviews of people’s care needs and identified risks were not regularly undertaken to ensure the care delivered still met their care and support needs. People felt there were no independent channels to raise complaints. A relative commented, “I feel unable to complain because it is a family business.” We found there were no effective systems to manage complaints.
There had been a significant deterioration in quality assurance systems since our last visit on 6 July 2017. The systems in place compromised the quality of care and safety of people who used the service. This was because they failed to identify and address any shortfalls in care, support and management systems. Where people were charged for the care and support received, they were not always given accurate information about the cost of their care.
People and relatives were generally happy with the care and support received. They told us staff were caring, respectful and treated them with dignity when providing intimate care. However, we were told about one example, where a relative felt their family member's dignity was not maintained and this had caused some stress. Staff felt the service was inclusive as it was a family business.
For 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 requires improvement (published 7 September 2017). Since this rating was awarded the service has moved premises. We have used the previous rating to inform our planning and decisions about the rating at this inspection.
Why we inspected:
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the full report.
Enforcement
We have identified breaches in relation to person-centred care, obtaining consent from people to receive care and support, safeguarding people from abuse, providing safe care and support to people, receiving and acting on complaints, ensuring staff are well supported and trained to provide effective care, recruiting staff that are suitable for the role, fees and good governance.
Please see the action we have told the provider to take at the end of this report.
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.
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.