Archived: Independent Care Solution

Updated 20 August 2019

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was prompted in part by information of concern related to a safeguarding concern about unsuitable staffing employed by the agency. We brought forward our planned comprehensive inspection.

Inspection team:

This inspection was carried out by two adult social care inspectors, one inspection assistant and one Expert by Experience. An Expert by Experience [ExE] 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 houses and flats in the community. It provides a service to older adults.

This service does not require a registered manager as the regulated activity accommodation and personal care is carried on by an individual who is registered with us in their own name. The individual, Mrs Gloria Ocampo, is in charge of day to day activity carried out by the service.

Notice of inspection:

We gave the service 48 hours’ notice of the inspection visit because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

What we did:

Before the inspection we reviewed information we had received about the service since the last inspection. This included details about events the provider must notify us about, information received from other stakeholders, such us the local authority and people using the service and their relatives. We also contacted external health and social care professionals and we received feedback from three of them.

During our visit, we spoke with the members of the management team, including the manager who was also the provider and the owner of the agency, the deputy manager and two care coordinators. We carried out telephone interviews with people who used the service. We received feedback from two people using the service and nine relatives.

We looked at records including nine people's care records, recruitment, training and supervision records for 12 staff members, and other documents relating to the management of the service.

Following the inspection, we contacted staff members and we received feedback from six of them.

Updated 20 August 2019

About the service: Independent Care Solution provides domiciliary care services to people living in the community within extra care schemes and within people's own homes. There were currently 35 people using the service at the time of our visit. The service provides personal care to older people living with dementia, people with physical disabilities and other high care needs.

People’s experience of using this service:

The quality of care and the management of the service had deteriorated since the last inspection. People’s safety and wellbeing had been put at risk and people were at risk of harm. Safeguarding procedures and polices had not been followed. The risk assessment and management process was not complete and personalised to each person using the service. Medicines were not managed safely and according to current national guidelines. The staff recruitment procedure was not robust to ensure people were protected from unsuitable staff. The care calls monitoring system was inadequate and people had not always received care.

Staff had not always received appropriate support and training to care for people effectively and safely. Staff roles, responsibilities and accountability were not clearly defined. It was not always clear if effective action took place to address staff’s unsuitable conduct or competence issues.

The Initial assessment of people’s needs had not taken into consideration all people’s needs, their life history and what their interests were. Care plans had not always reflected care that was provided to people. Records related to daily care were often not complete or not available for review by managers or for audit purpose. Therefore, the agency could not always say what exact care was provided to people.

People were at risk of not receiving appropriate nutrition. Staff had not been given enough information on people’s dietary needs and appropriate training to support people effectively and safely.

The principles of the Mental Capacity Act 2005 had not always been followed. There was a risk that people would receive care that was not in their best interest or safe.

We saw evidence that staff worked alongside health professionals when people needed support or their needs had changed. However, during our visit we came across one incident where staff had not contacted a health professional although this was required.

People and their relatives said most staff who supported them were nice and friendly. They said staff respected their privacy and dignity and encouraged people to participate in decisions about their care. However, during our visit we discovered information showing that staff had not always considered people’s needs or taken account of these in relation to people’s safety and wellbeing.

People could provide feedback about the service delivery via the complaint’s procedure, quality assurance questioners and discussion during the care review meeting. The feedback on how the agency dealt with concerns varied. All people and relatives spoken with said the provider investigated their concerns. However, some stated no effective action was taken to address these concerns.

The provider did not have quality assurance and monitoring systems in place to monitor the service delivery. There was no service improvement plan in place to address gaps in the service delivery. The provider was not aware of shortfalls highlighted by the inspection team during our visit. This suggested they could have been out of touch with what was happening within the agency.

Staff supported people to meet their cultural and religious needs. Staff supported people to have access to the community and attend appointments when needed.

When approached by external health and social care professionals the provider and the staff team worked collaboratively to provide the needed care to people.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have made four recommendation about professional boundaries and working within the social care ethos, the management of and learning from complaints, effective communication with staff team and gathering feedback from people about the service provided.

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.

The overall rating for this service remains as 'Inadequate'. We have kept this service under review while we took action to cancel the providers registration as a result of breaches in regulation resulting in people receiving inadequate care.

Rating at last inspection: Good (report published on 3 August 2017)

Why we inspected: This was a scheduled inspection of the service; however, it was prompted in part by information of concern related to a safeguarding concern and unsuitable staff employed at the agency.

Enforcement: For action we told provider to take refer to end of full report.

Follow up: We asked the provider to submit to the Commission an action plan to show how they will make changes to ensure the rating of the service improves to at least Good. We will continue to monitor the service and we will revisit it in the future to check if improvement have been made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk