Background to this inspection
Updated
12 June 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Our previous comprehensive inspection of this service took place on 13 June 2017. We found a number of breaches of legal requirements. We served a warning notice due to the failure to comply with Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance. We found the provider had ineffective systems to improve the quality of the service and ineffective audits.
In addition and following our inspection of the service in June 2017, the provider was required to display its performance rating at its office premises, and on its website. We found the provider had failed to do so which was a breach of Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Criminal enforcement action was taken and a fixed penalty notice was served. The provider accepted liability for the offence and paid the required penalty.
This announced comprehensive inspection of Crest Healthcare Limited took place on 8 March 2018 and 16 March 2018. The inspection had commenced as a focused inspection to consider notified concerns and the provider’s compliance with the warning notice issued previously. Due to the further concerns identified the inspection was expanded to a comprehensive inspection to enable a complete performance rating to be published. The inspection team on the first day of the inspection comprised of one inspector. The second day was also announced and conducted by a different inspector. The inspection visits were announced to ensure the manager was available to assist us with the review of documentation, and could receive the initial findings of the inspection. Following the inspection visit telephone calls were made to the provider’s care workers and to the relatives of people receiving a service.
In preparing for this inspection we considered the information supplied to us by the provider. The provider did not however meet the minimum requirement of completing the Provider Information Return (PIR) at least once annually. 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. Our records confirm the provider had started the PIR but it was not completed and submitted. We took this into account when we made the judgements in this report.
The provider had informed us of incidents at the service which had been reported to the local authority safeguarding teams or to the police. At the inspection we considered the on-going risks to people and care workers at the service, and sought to establish if the learning from the incidents had been reflected in the care provided to people.
We also contacted local authorities who provided the funding for people to ask them for information about the service. We were informed that any concerns identified by their own inspections and reviews were being addressed with the service. We also considered information available from other sources which included a notification that the provider and its directors were being prosecuted by The Pensions Regulator.
During our inspection, we spoke with the relatives of the three people who received personal care from the service. We were unable to speak directly to the people who used the service due to communication barriers. We spoke to the registered manager, the new office manager and five care workers. We also contacted a commissioner of services from the provider, and the social worker assisting one person.
We looked at and case tracked the care plans for all three people r
Updated
12 June 2018
We last inspected this service on 13 June 2017. A number of breaches of legal requirements were found at the inspection and the service received an overall performance rating of requires improvement. On 27 July 2017 we served a warning notice due to the failure to comply with Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance. We found the provider had ineffective systems to improve the quality of the service, and they had ineffective audits. The provider was given until the 31 October 2017 to demonstrate compliance with the regulation.
On 8 March 2018 we made an announced visit to the service and commenced a focused inspection to consider the provider’s compliance with the warning notice dated 27 July 2017, and to consider further information of concern received by us about the service. As a consequence of our findings from the first day, the inspection remit was expanded to a comprehensive inspection. A further announced visit to the service was made on 16 March 2018 to enable us to review further documents and speak with the registered manager.
The service is required to have and has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At this inspection we found that the provider continued to be in breach of Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition we found other breaches of legal requirements. You can see what action we told the provider to take at the back of the full version of the report.
Crest Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger physically disabled adults. At the time of this inspection three people were receiving personal care from the service.
CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
The provider failed to demonstrate clear oversight of the service and was not always aware of potential risks to people and care workers.
The provider’s systems and processes to assess and monitor the quality of the service were not effective in maintaining the required standards expected by us and other regulators. The provider had also failed to identify issues requiring immediate improvement.
People were not safe because some incidents of concern were not identified, or if they were reported, appropriate action was not taken.
People’s risk assessments, where available, did not always reflect the current risks for people and potentially placed them in danger of harm.
The provider did not ensure the care workers had sufficient support and effective training to undertake personal care tasks in compliance with applicable legislation and guidance.
The provider’s recruitment procedures were not consistently applied and did not adequately reduce the risk of employing unsuitable care workers.
People were supported to receive their medicines, however care workers had not been subject to regular competency checks and several mistakes or omissions were identified in the medication records.
People's support needs were recorded in care plans however there was a lack of evidence of reviews to ensure the care plans remained up to date.
People were able to make a choice about the food and drink made available to them to maintain their wellbeing, however where monitoring of the amount consumed was required this was not being done consistently.
The provider demonstrated knowledge and application of the legal requirements of the Mental Capacity Act 2005 and associated guidance and people were supported to have maximum choice and control of their lives. Care workers supported them in the least restrictive way possible; the policies and systems in the service support this practice.
People were assisted to be involved in activities in their local community and were supported to access health care professionals when required.
People were supported by caring and respectful care workers.
People and their family representatives knew how to complain or to express when they were unhappy about the service received.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms 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.