Archived: Curae Home Care

Rating at last inspection:

The last rating for this service was good (published 23 October 2019).

Why we inspected:

Prior to this inspection the CQC and Cornwall council’s safeguarding team received significant information of concern about the service’s performance. This included; reports of people’s visits being missed and late, reports of staff being employed without Disclosure and Barring Service checks being completed and concerns about the providers performance.

People’s experience of using this service:

We found the service was short staffed and there had been significant management changes since our last inspection. Both of the service’s senior staff were on maternity leave and a new deputy manager had been appointed. However, both the provider and the deputy manager were routinely completing care visits as the service did not have enough staff available to provide all planned care visits.

People and staff reported there had been a recent decline in the service’s performance and that planned visits had been missed, late and completed by insufficient numbers of staff. People’s comments included, “Until recently they always turned up. We have had quite a few problems. It is not the carers it is the management” and “[The staff)] are a really good team, but the management is beyond shocking.” Care plans and risk assessments showed people required support to access their medicines, manage their continence and to be repositioned to reduce risks of skin break down. Missed visits exposed people to risk of harm. It was specifically reported that the provider had failed to attend visits and staff told us, “I am not aware of any missed visits, other than the ones by the provider.”

The service did not have systems in place to record details of missed visits, investigate why visits had been missed or to try to identify learning where things had gone wrong.

In addition, we found the provider had routinely failed to complete records detailing the care and support they had provided. This included failures to record details of support with medicines. People were exposed to risk as it was not possible to establish what care had been given by the provider.

The service’s recruitment processes were unsafe. Necessary checks had not been completed to ensure prospective staff were suitable for employment in the care sector.

The provider was disorganised and unreliable. They did not give effective leadership to the staff team and their poor practice did not encourage staff performance. The provider failed to meet inspectors at agreed times on each of the three inspection days.

The CQC had significant concerns about the service, we wrote to the provider on the last day of our inspection requesting an action plan detailing what steps the provider intended to take to ensure people safety. The provider failed to respond to this request within the set timescales.

Enforcement: We found breaches of regulation. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: 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.

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

Curae Home Care is a domiciliary service providing personal care and support to people in their own homes. The office is situated on the outskirts of Bodmin and is accessible for people using the service and staff. The service was providing support for people living with dementia, learning disabilities or autistic spectrum disorder, mental health, people who misuse drugs and alcohol, physical disability and sensory Impairment. At the time of our inspection 30 people were receiving support from the service.

There was a registered manager in place at the time of our inspection. 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.

Staff were aware of the reporting process for any accidents or incidents that occurred and there was a system in place to record incidents. Where accidents, incidents or near misses had occurred these had been reported to the service's managers and documented in the service's accident book. There were systems in place to learn from incidents and to mitigate the risks of them occurring again.

The service provided safe care to people. Staff had received training in safeguarding adults and understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place, these included completing checks to make sure new staff were safe to work with vulnerable adults.

Medicines were managed safely and people received their medicines as prescribed. People's care plans contained risk assessments which included risks associated with people’s care. There were sufficient staff deployed to meet people's needs.

The service used assistive technology to record peoples care needs. The care planning system provided staff with direction and guidance about how to meet people’s individual needs and wishes. Care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person. Risk assessments gave staff the information they needed and guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

People told us they were involved in decisions about their care and were aware of their care plans.

People received effective care from staff who had the skills and knowledge to support them. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to maintain good health.

Staff had a good understanding of protecting and respecting people’s human rights. Staff spoke well about confidentiality, privacy and dignity and this came through when speaking with people.

People received personalised care by staff who understood people's individual needs and preferences. People's changing needs were responded to appropriately.

There was a complaints procedure which was made available to people and their relatives. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, survey and staff meetings to seek their views about the service provided.