Background to this inspection
Updated
5 June 2021
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 was carried out by one inspector and an 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.
The service did not have a manager registered with the Care Quality Commission. A registered manager is a person who is legally responsible for how the service is run and for the quality and safety of the care provided. It is a requirement of the provider’s registration that they have a registered manager.
Notice of inspection
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 provider or interim manager would be in the office to support the inspection.
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 reviewed a range of records, including six people’s care plans, care notes and medicines records. We looked at recruitment records for three members of staff. We reviewed documents related to the running of the service such as policies and procedures. We spoke with three people who used the service and ten family members. We spoke with five members of staff.
After the inspection
We continued to seek clarification from the registered manager to validate evidence found.
Updated
5 June 2021
About the service
This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection, 31 people were using the service.
People’s experience of using this service
People’s experience of using the service varied. Those who were regularly attended by experienced or enthusiastic newer care workers spoke highly of them and we received exceptional or very good feedback about named members of staff. Others commented on the high turnover of staff and lack of skill in staff. Comments we received included, “They are absolutely wonderful, so helpful” and “Some staff do the minimum and get away with it.”
Staff training arrangements had been impacted by the Covid-19 restrictions, and since then not all inductions and refresher training had been completed. The service had begun to use online and video training but there were still significant deficits which potentially put people at risk. For example, people were being supported with their medicines by staff who had not been recently trained in the management of medicines or had their competency suitably assessed.
Medicines records were not always being correctly kept. People’s medicines assessments did not always contain all the information required to keep them safe. Audits of these records failed to identify many of the issues we found. Appropriate action had been taken where issues had been identified.
People told us their care workers usually arrived as expected but this was not always consistent. It was a common belief among people and their relatives that the service was short staffed.
The service was not keeping effective records of quality issues, complaints, safeguarding alerts and incidents. The manager described areas of improvement being looked into at the time of inspection, but these were not formally documented in an ongoing improvement plan.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 15 July 2019) and we found a breach of the regulations relating to management of medicines.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carby Community Care Ltd on our website at www.cqc.org.uk.
Enforcement
We have identified a breach in relation to the safe management of medicines and the governance of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.