Archived: Xtracare Agency Ltd

Updated 16 March 2016

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.

This inspection took place on 12 and 19 January 2016, and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in.

The inspection was carried out by two inspectors. Before the inspection, we looked at information about the service we held, including notifications. A notification is information about important events, which the service is required to send us by law.

We spoke with three people and two relatives who use the service. We also spoke with the registered manager, the care co-ordinator and six care workers.

We looked at ten care records, five staff records and other records relating to the management of the service.

After the inspection, we spoke with representatives from the local authority commissioning teams and safeguarding teams in the London Borough of Lambeth and in the London Borough of Southwark.

Updated 16 March 2016

This inspection took place on 12 and 19 January 2016 and announced. Xtracare agency Ltd is a domiciliary care service. The service provides personal care for people living in their own homes. At the time of the inspection, 26 people were using the service.

The service had a registered manager in post. 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.

The last time we inspected this service in February 2014 the service was meeting all the regulations we inspected.

At this inspection, we found the provider had breached six of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to person-centred care, need for consent, safe care and treatment, safeguarding service users from abuse, good governance and staffing. CQC is considering the appropriate regulatory response to resolve the problems we found in respect of these regulations. We will report on action we have taken in respect of these breaches when it is complete.

The provider had safeguarding policies in place to give staff guidance to protect people from an allegation of abuse. However, people were at the risk of abuse because staff had not promptly raised allegations of abuse we found. People were at risk of receiving unsafe care because the registered manager and staff had not updated and reviewed people’s care plans or assessments. Risks to people were not routinely identified or plans were not in place to monitor and manage risks. There were insufficient staff to meet people’s care and health needs because the service did not have an accurate record of the numbers of people they provided services for.

The management of people’s medicines were not safe because staff did not have medicine management training. Medicine administration records (MAR) were not fully completed and medicine audits did not occur. Therefore, it was unlikely that the registered manager could detect medicine errors and take action to reduce the likelihood of unsafe medicine management.

Staff did not have any support, induction, supervision, appraisal, and training to support them in their caring roles. The registered manager did not provide staff with an opportunity to discuss and plan training and support. The registered provider did not have processes in place to ensure that staff were equipped to appropriately care and support people.

The registered manager and staff did not understand the requirements and their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had not obtained consent from people or their relative when providing them support to meet their needs. Staff we spoke did not have an awareness or knowledge of consent or mental capacity assessments.

Staff did not support people to access health care when required. People did not receive a service, which was responsive to their needs. Staff did not respond to people’s changing care needs and the way care and support was delivered did not meet their individual needs promptly. Staff had not recognised that people could benefit from referrals to health and social care professionals for additional support or equipment.

People were not always treated with kindness and compassion by staff. People we spoke with told us staff were kind and caring. We found that staff did not identify and act on people’s needs promptly which demonstrated a lack of kindness and compassion.

People or their relatives did not make decisions about their care because they did not have the opportunity to do so. The registered manager had no arrangements in place to enable people’s involvement in or make decisions about their care.

Assessments of people’s care needs were completed on an initial visit to them. However, people did not contribute to the assessment or planning of their care. There were no processes or systems in place to ensure people had regular reviews of their care needs.

The registered provider had systems in place for people to complain about the service or aspects of their care. When people started using the service, they had a copy of the service’s handbook, which had a copy of the provider’s complaints policy and process.

The provider did not have a system in place that sought people’s feedback on the service. People and their relatives did not have opportunities to give their views about the quality of care. Staff were not able to provide feedback to the registered manager, because this was not in place. The registered provider did not arrange meetings for staff and they did not have the opportunity to make suggestions about how to improve the service.

The day to day operation of the service was not effectively led, coordinated, and managed by the registered manager. They did not demonstrate an understanding of their responsibilities as a registered manager. Office bases staff did not receive clear leadership and support to deliver their roles effectively. The registered manager did not have an overall view of the service because they were not always in the office.

The recruitment process used by the service was robust; staff employed at the service had appropriate checks carried out before working with people. People had their meals provided by staff, which met their needs and preferences.

People had respect from staff and their dignity maintained. People had care delivered in their home and had privacy when they wished. People told us and records showed that staff had delivered care which, demonstrated staff respected their privacy and whilst retaining their dignity.

People’s care records were stored securely in a locked cupboard. Staff had access to people’s record when they required this.

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, 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.