Background to this inspection
Updated
23 September 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
The inspection was carried out by one inspector.
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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
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 activity started on 06 September 2022 and ended on 30 September 2022. We visited the location’s office on 08 September 2022.
What we did before the inspection
We reviewed information we had received about the service since our last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is. This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make.
During the inspection
We visited the service and met with the registered manager and nominated individual, who was also the provider. The nominated individual is usually responsible for supervising the management of the service on behalf of the provider. We reviewed care records for two people, documentation in relation to the running of the service and policies and procedures. We reviewed recruitment information for one staff member. In addition, we spoke with one person, one relative and one staff member to gain their views of the service.
Updated
23 September 2023
About the service
Adorn Care Services Ltd provides personal care support to people in their own homes. At the time of our inspection the service was supporting two people with personal care needs.
People’s experience of using this service and what we found
People and relatives gave positive feedback regarding the care they received. However, we found
the provider had failed to implement systems and processes to ensure people’s safe care. Risk assessments lacked detail and guidance for staff and no process was in place to monitor accidents and incidents. Medicines were not managed robustly and infection prevention and control guidance was not consistently followed.
The nominated individual and registered manager were unable to demonstrate the skills required to provide a registered service. Quality assurance audits had not been implemented which meant concerns were not identified. Systems to monitor the quality of the service such as spot checks and monitoring calls were not robust and not completed regularly. Following our last inspection, the provider forwarded an action plan stating what they would do to make improvements. At this inspection we found this had not been followed and there was a continued lack of managerial oversight.
Accurate, complete and contemporaneous records were not maintained. People’s care plans lacked information regarding how people preferred their support. Daily records were not organised, were difficult to read and did not consistently record the times and names of staff members visiting. The registered manager and nominated individual were unable to demonstrate understanding of the Mental Capacity Act 2005 and how this impacted on their work. The registered manager told us a number of records we requested were held on a system they had been unable to access for several months.
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 18 January 2022). 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.
Why we inspected
We carried out an announced comprehensive inspection of this service on 6 December 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, fit and proper persons employed and good governance.
We undertook this focused inspection to check whether Warning Notices in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and that the providers action plan had been followed. This report only covers our findings in relation to the Key Questions Safe 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 remains Inadequate.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Adorn Care Services 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 continued breaches in relation to how risks to people’s safety are managed, medicines management, infection prevention and control and good governance at this inspection.
CQC’s regulatory response to the serious concerns found was to cancel the providers registration.
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.