Background to this inspection
Updated
30 April 2022
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 team consisted on two Inspectors and one 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 homes or place of living.
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. In this case, the provider and registered manager are the same.
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 registered manager would be in the office to support the inspection.
Inspection activity started on 9 February 2022 and ended on 23 February 2022. We visited the office location on 9 February and 14 February 2022.
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 and professionals who work with the service.
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 with nine people who used the service and 10 relatives about their experience of the care provided. We spoke with the registered manager, the office manager and an independent care consultant who was providing support and guidance to the provider. We received feedback from nine members of staff. Despite us asking, the registered manager did not make arrangements for care staff to come along to the office whilst we were there. We were able to speak to four members of staff by telephone.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at seven staff files in relation to recruitment, training and staff supervision. We reviewed other records relating to the management of the service, namely policies and procedures, medication administration records, daily care rotas were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at all the records we gathered during the inspection. We asked the registered manager to provided records they had been unable to locate during the inspection and asked them to submit these to CQC by 17 February 2022. The service was unable to provide all the records we requested.
Updated
30 April 2022
About the service
The Carer Network is a domiciliary care service providing care and support services to people in their own homes or place of living. At the time of the inspection, the service was supporting 42 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. The Care Network were currently supporting 26 people with personal care tasks.
The service is responsible for ensuring the regulated activity of personal care is delivered safely to all service users. Some people received a service from a micro-provider, they were able to self-direct their service, or relied upon a relative to do so.
People’s experience of using this service and what we found
People did not receive a service that was well-led. The leadership and management of the service was poor. The registered manager did not have oversight of how the service was performing, having previously relied upon their former business partner. There were no measures in place to adequately monitor the quality and safety of the service.
People did not receive a service that was safe. Safeguarding concerns were not always reported to the local authority in a timely manner. Risks affecting people’s health and welfare were not consistently managed and there was conflicting information recorded in care planning documentation. The service did not follow safe recruitment practice which increased the risk of people being looked after by unsuitable staff. We were unable to establish if staff had received appropriate training in the safe administration of medicines. We were not assured that staff members had received the appropriate level of infection prevention and control training or that the staff were fully compliant with COVID 19 testing.
People did not receive a service that was effective. The assessment of people’s care and support was not always documented clearly. There was a difference in the information recorded in paper and electronic care records. The training that was offered to staff was not adequate. New staff who joined the team did not receive an induction training programme, this included new recruits who had not worked in the care sector before. The measures in place to monitor staff members work performance were either absent or not effective.
People did not always receive a service that was responsive to their care and support needs. Whilst improvements had been made in ensuring each person supported by the service had a care plan, the level of detail in these was minimal, could be conflicting and was not always up to date. Complaints were not handled correctly. We were told about complaints that had been made where there were no records available and the registered manager was unaware whether others had been resolved.
There was a mixed response from people using the service and their relatives. Those who received a service from a micro-provider were satisfied with the care and support they received. However, those who received their support from staff employed by The Carer Network, the feedback we received was not so positive.
There was no reference to capacity assessments in care planning documentation. Staff had not received any training in the Mental Capacity Act (2005). However, we had no evidence to suggest people were not supported to have maximum choice and control of their lives, nor that staff did not support them in the least restrictive way possible and in their best interests.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The service was registered with us on 23 November 2020 and this is the first inspection.
Why we inspected
This was a planned inspection but was brought forward due to concerns about the leadership and management of the service. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see all sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified breaches in relation to safe care and treatment, safeguarding, management of complaints, staffing, recruitment and governance.
Please see the action we have told the provider to take at the end of this report.
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.
Special Measures
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.