Background to this inspection
Updated
2 March 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 three inspectors and two Experts 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.
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 announced the inspection and gave the provider 72 hours' notice prior to visiting people in their own homes so we could gain their consent. We did not give notice prior to the office visit due to our concerns about the management of the service.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) 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 reviewed the information we already held about the service and provider. This included information from the ongoing whole service safeguarding process with the local authority and external health professionals.
During the inspection
We spoke with 9 people that used the service, 15 relatives, the registered manager, the provider, the deputy manager and 2 care staff in person. We also were contacted by 4 current care staff and 3 ex-care staff. We sent staff questionnaires to 10 further staff but only received one response.
We reviewed documents and records that related to people's care and the management of the service. We reviewed 16 care plans and 3 staff files, which included pre-employment checks. We looked at other documents such as training, medicine and quality monitoring records.
Updated
2 March 2023
About the service
1st React Healthcare – 1st React Healthcare Domiciliary Agency is a domiciliary care agency based in Exmouth. The service provides personal care to adults in their own homes. 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 the inspection, the service was supporting 59 people with personal care.
People's experience of using this service and what we found
Robust systems were not in place to ensure staff attended calls in a timely way for the commissioned length of time. People and relatives all told us they did not know which staff were visiting and when. They told us staff did not always stay for the correct amount of time and this was confirmed by daily records. Daily notes often stated that people did not want anything else doing when there was a short visit, but people and relatives told us the staff voiced to them they were busy and short staffed and so were reluctant to ask them to stay. This meant that tasks were sometimes not completed despite specific health conditions and care plan instructions and staff did not have time to talk to people.
All staff, people and relatives spoken to voiced concerns about missed visits and the difficulty in contacting the service. The registered manager said there was not an issue with missed visits, but this was a theme in each person’s feedback to us. We saw messages sent to the office by one relative in July, September and October 2022 not being answered in a timely way asking where the carer was for their husband. This person should have had a morning visit for support with washing and dressing, but their December schedule had visits booked between 10.30 and 14.00.
Robust risk assessments were not in place in relation to people's health conditions and security to ensure they received safe care at all times.
Medicines were not being managed safely as people did not always have Medicines Administration Record when staff were supporting with medicines. People’s records did not always have a list of the medicines they were taking.
Pre-admission assessments and care plans did not involve people to ensure people's preferences with support and care were captured. The service did not carry out their own assessments prior to accepting care packages but waited for local authority assessments.
Care plans lacked evidence that people were being involved in decisions about their care. Staff said they did not always know what people needed when they visited them, and people did not see regular staff. One person had 12 different staff in a 7-day period.
Robust quality assurance systems were not in place to identify shortfalls and take prompt action to ensure people received safe and effective care at all times. The core issue of a lack of staff to cover the care package hours, poor scheduling and people not receiving allocated times they preferred had not been addressed.
Staff did not feel supported in their roles and told us they were unable to deliver the support people required.
People had choices during mealtimes, but people spoke of missed visits meaning they had no meal.
People were supported to access healthcare services, but short-term conditions such as pressure sores or chest infections were not monitored within records to ensure timely referrals or monitoring.
People were not always given the time commissioned to be encouraged to be independent and to carry out tasks without support.
Pre-employment checks had been carried out to ensure staff were suitable to support people.
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, published 14 September 2021.
Why we inspected
We had received concerns from staff, ex staff and relatives and a whole service safeguarding process was in place. Therefore, we wanted to visit people to see what their experience of the service was.
Enforcement
We have identified breaches in relation to safe care and treatment, staffing, training, person centred care and good governance. Please see the action we have told the provider to take at the end of this report. 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.
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 six 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.