27 June 2023
During an inspection looking at part of the service
Iconia Grays is a homecare agency providing care to people in their own homes. The service provides care to older people, people with a learning disability and/or autistic people, people living with mental health needs, dementia and physical disabilities. 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 our inspection the service was providing personal care to approximately 33 people. The provider failed to supply evidence of the exact number of people supported.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. At the time of our inspection the service was supporting one person with a learning disability.
People’s experience of using this service and what we found
Right Support:
Robust safeguarding procedures were not embedded into practice. Concerns had not always been reported to the local authority as required and systems were not reviewed to minimise the risk of them happening again. Risks to people’s safety were not always identified or mitigated. There was limited guidance for staff on how to support people safety or in relation to their specific health conditions. People did not always receive their medicines safely and referrals to health care professionals were not made in a timely manner.
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. The principles of the Mental Capacity act were not consistently followed. Not everyone being supported by the service had received an assessment by the provider and some people did not have a care plan in place to guide staff as to their needs and preferences. This meant staff were not always aware of people’s needs and preferences which had led to concerns regarding the care they received.
Safe recruitment practices were not consistently followed to ensure staff were suitable for their roles. The competence of staff was not robustly assessed and staff induction and training was not thorough. Care calls were not planned in an organised way which led to people not receiving their calls as required. People did not always receive their care calls on time and there were multiple occasions of people’s care calls being cut short.
Right Care: Although people described the majority of staff as being kind and caring, the service was not consistently personalised due to shortfalls in care planning, risk management and oversight.
There was limited information available to staff regarding people’s life histories, families and interests. Staff we spoke with were often unable to tell us personalised information about people. Care plans did not contain information about people’s communication needs and people told us communication could be difficult due to staff not always being able to speak and understand English well.
Right Culture: Effective quality assurance measures were not embedded to ensure a culture of continuous improvement. Audits and spot checks of staff competence had not been completed routinely and accidents and incidents were not reviewed to minimise the risk of them happening again.
The provider did not share information in an accurate or transparent manner. Numerous discrepancies were found between information given by the provider and details obtained from records, staff and other professionals. Discrepancies included basic details such as the number of people supported, how people’s care was funded and how many staff were employed. The provider had not notified CQC of safeguarding concerns and changes to the management structure of the service as required by their registration.
Feedback from people regarding the quality of the care they received was not regularly sought. Staff meetings were not used as a forum to share ideas and learning but as a way for the provider to share instructions. Staff did not receive regular supervisions to support them in their roles.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection The last rating for this service was good (25 January 2023)
Why we inspected
The inspection was prompted in part due to concerns received about people’s safe care, how staff were recruited and a lack of transparency from the provider. A decision was made for us to inspect and examine those risks. We found improvements needed to be made in these and other areas and identified multiple breaches of regulations.
The overall rating for the service has changed from good to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
We have identified breaches of regulations in relation to safeguarding systems, safe care and treatment and staff recruitment, deployment and skills. We have also found people's care was not person-centred, people’s consent was not always sought in accordance with the law, and there was a lack of management oversight at this inspection.
During the inspection we raised a number of safeguarding concerns with the local authority in relation to people’s safe care and treatment. An action plan was also requested from the provider regarding the steps they were taking to make improvements. The local authority have taken action to keep people safe and to monitor their care.
CQC’s regulatory response to the serious concerns found was to cancel the providers registration.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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 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 of their 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.