Archived: CRG Homecare Hackney

CRG Homecare 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 the whole population. Not everyone using CRG Homecare receives a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection, it was providing a service to 40 people.

People’s experience of using this service and what we found

People and their relatives told us they felt safe. However, the service was not always run safely. The provider had not always identified risks to people’s health and wellbeing or developed guidance for staff about how to reduce identified risks. People were not fully protected from the risk of poor practice because staff were not aware how to escalate concerns to local safeguarding teams or the CQC.

People were at risk of not getting their medicines as prescribed. Medicine administration records did not include all medicines that had been prescribed and medicines that were no longer prescribed were being recorded as given. There were no protocols available for medicines people received on an as required basis.

The provider did not have robust and effective systems and processes to ensure the quality and safety of the service.

People told us there were not enough staff who had the right training and skills to meet people’s needs.

People told us the care staff were friendly and they knew how to make a complaint if required. Staff explained how they supported people’s independence and respected their diversity.

The provider met people’s hydration and nutritional needs and supported people to get medical treatment where required.

People were supported to have maximum choice and control of their lives and staff supported them in the

least restrictive way possible and in their best interests; the policies and systems in the service supported

this practice.

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 2 November 2018) and there were multiple breaches of regulation. 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. The service has deteriorated to inadequate. This service has been rated requires improvement or worse for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safeguarding people from abuse, safe care and treatment, staffing and good governance.

We have repeated a recommendation regarding end of life care.

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.

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 6 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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses, specialist housing and flats in the community. It provides a service to older adults. At the time of our inspection 50 people were using the service.

The service had not had registered manager for eight months. There was a branch manager who was currently in the process of becoming 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 at the service did not have robust risk assessments as they were not accurate and did not include details about people obtained as part of their needs assessment or initial assessment of need. We found medicine’s, falls and nutritional risk assessments incorrectly completed.

Medicines management was not robust. The level of support people received did not always correspond to the assessment of need. Medicine administration records were not always completed accurately and had medicines listed that were no longer prescribed.

Staff knew what abuse was and who to report an allegation of abuse to. However, not all staff were aware of the whistleblowing procedure and where to report concerns outside of the service.

Staff recruitment improved in later files we viewed. Pre – employment checks and references were now verified in all cases and staff had to complete criminal records checks before commencing employment. The service had introduced competency assessments in maths and English for new staff joining the service.

People told us they felt safe in their home with staff at the service but staff did not always arrive on time especially at weekends.

Staff received a full induction which included mandatory training and training in the care certificate. Staff received regular supervision where they were informed about their current performance and areas for improvement.

People received an assessment of needs and people told us they thought staff were good at their jobs.

People were supported with nutrition and hydration if they had been assessed as needing support in this area. Some nutritional support staff provided was outside the remit recorded in the care plan and risk assessment. We informed the branch manager of this.

People were encouraged to make their own decisions and where people lacked capacity Mental capacity assessments were carried out but in some cases these were not completed correctly. We have made a recommendation about the understanding of the Mental Capacity Act 2005.

People were supported to maintain good health as staff from the service helped them to access health professionals as needed.

People thought staff were kind and caring and respected their privacy and dignity. Relatives were not so positive and had not so good interactions with staff from the service.

People’s spiritual and cultural beliefs were respected and supported by staff and the service was inclusive and non-discriminatory.

People’s confidentiality was respected and staff did not discuss people outside of the service.

Care plans were person centred and gave information about the person so staff at the service could get to know them. However, care plan reviews did not take place in a timely manner and where reviews did take place information from the reviews was not updated promptly on people’s care plan.

Call monitoring records showed that staff were not arriving at the correct times or staying for the duration of the call which meant care was not always responsive to people’s needs.

The service responded to complaints and staff supported people to make a complaint if they were unhappy with the service. However, some people and relatives told us they did not always make a complaint when they were dissatisfied with the service. We have made a recommendation about the management of complaints

End of life wishes were not always discussed with people at the service.

Governance was not robust at the service. The provider audited the service and provided them with an action plan to work through. The branch manager had audit tools which were not being used effectively as they did not identify the concerns regarding the quality of documentation, missing information and accessibility of records which we found during our inspection.

People told us they liked the branch manager and thought the service was well led. People and relatives wanted to see an improvement in staff arrival times.

Staff felt supported by management and felt the atmosphere at the branch was welcoming and they appreciated the open-door policy at the branch.

After the inspection the service sent us an action plan with improvements they had made to improve the quality of the service.

We found three breaches of the regulations in relation to safe care and treatment, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.