Archived: Care 24x Limited

Updated 18 May 2023

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 Health and Social Care Act 2008.

Inspection team

This inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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

This inspection was announced. 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 activity started on 05 April 2022 and ended on 22 April 2022. We visited the location’s office on 22 April 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) immediately prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with four people who used the service and five relatives about their experience of the care provided. We spoke with seven members of staff including the nominated individual, the manager and the care coordinator. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 18 May 2023

About the service

Care 24X Limited is a domiciliary care agency which provides personal care to people living in their own homes. At the time of the inspection 18 people were receiving personal care. 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.

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

Feedback from people and their relatives was mixed. Whilst in the main people were positive about the care staff, feedback about the management of the service was not positive. Comments included, “The carers are lovely, and I can’t fault them”, And, “We didn’t have any induction, brochure, contact numbers. No one phoned. I had to look up on the website for a contact number for them.”

The support provided to people continued not to be safe. People’s needs were assessed. However, risk assessments were not in place for some risks. Other risk assessments lacked information to provide guidance to staff. We identified an incident which had not been investigated or reported to the local authority or CQC when it should have been. There was no effective system for learning lessons from incidents.

Medicines were not managed safely. For example, some information for ‘as and when’ medicines was not in place when it needed to be.

There was not enough staff suitably deployed. Staff did not always arrive on time. People and their relatives told us staff sometimes arrived early for evening calls and the records reflected this. Staff had no travel time between calls and left calls early. Staff were not always recruited safely to ensure they were safe to work with vulnerable people.

The provider continued to rely on staff training provided by staff’s previous employment and had not checked this training was of a good standard. The provider didn’t have sufficient oversight of what training staff had or had not done or when refresher training was due. Staff has not been trained in areas such catheter care and were providing this support.

People were not always supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not support this practice. Staff understood the Mental Capacity A and knew to offer people choices. However, the provider had not kept records to confirm where relatives had power of attorney.

Systems in place to monitor and improve the quality of the service were not effective. Audits had not always identified concerns. Where concerns had been identified action had not been taken to address the concern. The provider was not able to demonstrate they had undertaken spot checks to assess staff performance or that all staff had had a recent supervision.

There was no evidence people and their relatives had been asked their views about the service. People and their relatives told us they did not know who the manager was and communication with management was poor.

Staff wore personal protective equipment, such as face masks, when they provided support to people. People were supported with meals and drinks where they needed this support. People were supported to access healthcare. The service worked in partnership with other services such as healthcare providers.

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 (29 December 2021). The service remains rated inadequate. This service has been rated inadequate for two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. And in breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We also identified new breaches in regulations of regulation 13, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

We carried out an announced comprehensive inspection of this service on 25 June 2021 and 28 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance and notifying CQC of incidents.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed from 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 Care 24X Limited 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 monitor the service and will take further action if needed.

We have identified breaches in relation to staffing levels, providing safe care, the management of the service, protecting people from abuse, safe staff recruitment, and reporting significant events to CQC 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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.