Archived: Independent Care Solution

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

At our previous inspection on 14 July 2016 the service was in breach of Regulation 12 due to poor risk assessment procedures and management of medicines. The service was also in breach of Regulation 13 as mental capacity for some people was not being assessed or responded to. At this inspection we found the service had resolved these two previous breaches of regulation and the overall rating has improved from requires improvement to good.

The provider was also the registered manager. 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.

People using the service had a care plan which contained information about the person and their care needs and requirements. As part of the care planning process, the service carried out generic risk assessments which covered risks associated with the environment, moving and handling and health and safety. This had improved since the previous inspection and risk reduction measures were included in risk assessments.

A person using the service and other people’s relatives we spoke with told us they felt safe in the care of the care staff that supported them. Care staff were able to identify the different types of abuse and were clear on the actions that they would take if they suspected any abuse was taking place in order to protect and keep people safe.

The registered manager and care staff had a good understanding of the Mental Capacity Act 2005 and how this impacted on the provision of care and support. Care plans now demonstrated that mental capacity assessments took place. Action that was needed as a result of people potentially lacking capacity was taken. Where the local authority had completed a mental capacity assessment, we saw documents relating to this within care plans.

Care staff told us, and documents confirmed that they received training in the safe administration of medicines. Medicines recording and monitoring had improved and there were more robust systems in place to monitor safe medicine administration and recording.

A person using the service and other people’s relatives told us that they were very happy with the care that they received and that they had a regular group of carers that attended to their care needs. Care plans had improved and were more detailed and person centred.

The service had safe recruitment processes in place which included obtaining references and the completion of a criminal record check prior to the care staff commencing their employment. Care staff we spoke with told us that they felt supported in their role and received regular supervision and appraisals, which records confirmed.

Care staff, when they first started working at the service, received an in-house induction and training in all mandatory subjects which included first aid, safeguarding, moving and handling and medicine administration. We saw evidence that care staff received annual refresher training in core care topics, including safeguarding and moving and handling.

The registered manager was ‘hands on’ and involved in the day to day management of the service. Regular spot checks took place and observations were carried out along with regular reviews of people’s care and support needs. Missed visits were now monitored and recorded, action required to investigate reasons for missed visits was taken and this was recorded.

The service had a complaints policy which was given to people using the service and relatives. The registered manager reported that she had not received any formal written complaints. People told us they could contact the service if they had any concerns or queries. People usually felt that they received an appropriate response when they made contact.

Quality assurance questionnaires were completed on an annual basis from the date the person began using the service. Feedback was seen to be positive. There was improved auditing although no action plan had been developed as the result of the most recent survey in December 2016.

As a result of this inspection we found that the provider had improved and now complied with the regulations. Please refer to the main body of this report for further details.

The provider had moved offices in September 2014 and so this was the provider’s first inspection since it had been registered at the new address. The service, when last inspected in July 2014 at the previous address had met all outcomes of the regulations that were inspected at the time.

Independent Care Solutions provides domiciliary care services to people living in the community within extra care schemes and within people’s own homes. There were currently 39 people using the service. The service provides personal care to older people living with dementia, people with physical disabilities and other high care needs.

The provider was also the registered manager. 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.

Each person using the service had a care plan which contained basic information about the person and their care needs and requirements. As part of the care planning process, the service carried out generic risk assessments which covered risks associated with the environment, moving and handling and health and safety. However, although the service identified people’s individualised risks, these were not assessed and guidance was not provided to care staff on how to mitigate or reduce the risk of harm.

People we spoke with told us they felt safe in the care of the staff members that supported them. Care staff were able to identify the different types of abuse and were clear on the actions that they would take if they suspected any abuse was taking place in order to protect and keep people safe.

The registered manager and care staff had a good level of understanding of the Mental Capacity Act 2005 and how this impacted on the provision of care and support. However, care plans that we looked at did not evidence that the service completed any form of mental capacity assessment. There was no recorded information of any best interest decision that had been taken on behalf of person who lacked capacity. Where the local authority had completed a mental capacity assessment, we saw documents relating to this within the care plan. However, in one particular care plan, the assessment and best interest decision did not reflect the care and support a person was receiving especially relating to the potential use of restraint.

One care plan that we looked at we noted that the support a person required involved the need for care staff to hold the persons hands whilst the second carer supported them with personal care. This could potentially be interpreted as the use of restraint. The service had not provided any training or guidance to care staff on how this should be done in a safe and least restrictive manner as per their own restraint policy.

Care staff told us, and documents confirmed that care staff received training in the safe administration of medicines. However, on the day of the inspection we found that the service did not list the names of the medicines on the Medicine Administration Record (MAR) and care staff did not sign any records using their initials but instead used a coding system which only stated that they had observed the person taking the medicine. We were unable to identify which care staff had administered the medicine and care staff were unaware of what medicines the person was taking, when they must be given to person and what dose must be administered. For one person we found that care staff were administering eye drops but there was no record of this and there were no MAR available confirming that care staff had administered the drops.

People told us that they were very happy with the care that they received and that they had a regular group of carers that attended to their care needs.

Care plans were not detailed and were not person centred. Some care plans that we looked at had some basic background information about the person but this was not consistent within all the care plans.

The service had safe recruitment processes in place which included obtaining two references and the completion of a criminal record check prior to the care staff commencing their employment. Care staff we spoke with told us that they felt supported in their role and received regular supervision and appraisals. Records also confirmed this.

Care staff, when recruited, received an in-house induction and training in all mandatory subjects which included first aid, safeguarding, moving and handling and medicine administration. We saw evidence that care staff received annual refresher training in all mandatory topics.

The registered manager was very ‘hands on’ and involved in the day to day management of the service. We saw evidence of regular sport checks and observations that were completed and regular reviews taking place which were dependent on people’s level of need. However, missed visits were not formally monitored or recorded.

The service had a complaints policy which was given to people using the service and relatives when the service commenced. The registered manager told us that she had not received any formal written complaints as people or their relatives would always call her directly if they had any concerns and she would make a point of visiting them immediately to resolve any issues or concerns.

Quality assurance questionnaires were completed on an annual basis from the date the person began using the service. Feedback was seen to be positive. However, there was not analysis of the results to enable learning or improvements to service provision.

We have identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in Regulation 12 and 13 and were in relation to assessing risks associated with people’s care and support needs, safe medicine management and assessing mental capacity and ensuring that best interest decisions are made in collaboration with all involved and recording this within the care plan. You can see what action we told the provider to take at the back of the full version of the report.