Archived: CRG Homecare Stockton

Following significant concerns raised at the last inspection about the safety of people using the service the provider handed back the care packages for 230 people.

People’s experience of using this service: During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to ensuring the safe care of people, obtaining valid consent, dealing with complaints and effective governance arrangements.

People told us that staffing levels met their needs. However, we found it difficult to establish how the office staff monitored compliance with this, as they did not have accurate information on the care packages being provided. We were told 11 people required personal care but found 36 people were receiving personal care. Local systems to oversee calls were ineffective and staff did not monitor missed, late and unallocated calls.

A manager had started to work at the service a few days before our inspection commenced but left after two weeks and a new acting manager came into post. This lack of oversight and leadership led to most people having problems with staff turning up to provide their support.

We were initially told that everyone had capacity and therefore MCA assessments and 'best interests' decisions were not needed. However, this was incorrect, as some people lacked capacity to make decisions and were subject to Court of Protection deprivation of liberty safeguards. No capacity assessments or best interest decisions were in place for these people to confirm the restrictions that were being imposed.

The provider had been working to improve the risk assessment documentation. Further work was needed to ensure all risks were thoroughly detailed. It was difficult to determine if the care records were truly accurate as staff could not tell us what support people received. When staff supported people with their medicines there was limited independent oversight, as at times staff audited their own work. For some people there was no information was available to support staff should they need to administer as required and emergency medication. This lack of oversight left people at risk in the event of an emergency.

Incident monitoring records were used, and events were reviewed so lessons could be learnt. However, not every incident was recorded. From September 2018 five missed calls were recorded in the incident log however, there had been 165 such events. Safeguarding concerns were not always reported to senior managers or investigated. The lack of accurate information meant the provider was under-estimating problems at the location so had not taken sufficiently robust action to address these concerns.

People were dissatisfied with the way complaints had been managed. The provider was unable to provide us with the outcomes for complaints that had been raised. Everyone we spoke with had raised concerns around the difficulty of being able to contact people in the office. The provider was aware of this issue and was taking steps to rectify this matter.

The staff training, and supervision were being completed but were not fully up to date. The provider had identified gaps in training and put processes in place to rectify this issue.

We found the provider had been committed to making improvements and had developed comprehensive action plans that they were working through. However, we found that these currently had not supported staff to put the basics in place such as understanding the care packages they were to deliver.

People spoke extremely positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. People told us that staff knew them and they generally had the same staff attending calls. Staff knew when to involve healthcare professionals and what action to take in an emergency. Staff assisted some people make their own meals but were led by the person’s choice.

The day after we concluded the inspection the provider handed the care packages back to the local authority.

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

Rating at last inspection: This service was rated as inadequate (Report published October 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The overall rating for the service is inadequate, the service remains 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 to check on improvements.

This service also provides care and support to people living in specialist ‘extra care’ housing in Stockton-On-Tees. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care [and support] service.

At the time of the inspection there were 311 people using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager had been in post since 7 March 2016, however they had not been working at the service for at least one month. During the interim period, the regional manager was based at the service and an acting manager was in place. 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.’

At the last inspection on 31 May 2017, we found improvements were needed to the quality of record keeping at the service. Records relating to the care and treatment of people using the service were not always accurate or updated when people’s needs changes. Audits had not identified these concerns. After the inspection, the provider supplied an action plan, which was dated 21 August 2017 which said, all of the required improvements would be completed by 31 October 2017.

At this inspection, we found these improvements had not been made. In May 2018, the provider had accepted a significant number of new care packages. Local authority commissioners had raised a number of concerns around the operation of the service. The provider agreed as part of the serious concerns protocol, to a voluntary embargo on accepting new care packages in some aspects of the service. After inspection feedback, the provider placed their own embargo across all aspects of the service.

At this inspection, we found staff were not responsive to risk and safeguarding alerts had not always been raised when needed. Accidents and incidents were not routinely recorded and systems had not been in place to ensure lessons were learned. Risk assessments were not always in place. Those in place lacked information about how to reduce the risks to people. Medicines were not always managed safely for people and records had not been completed correctly. There were gaps in recruitment and there were insufficient staff in all areas of the service to meet the needs of people. Infection prevention and control procedures were not routinely followed.

Staff had not been supported through their induction. Supervision, appraisal and training were not up to date. Staff lacked understanding about people’s nutritional needs, as a result there was a lack of oversight. People were supported to make and attend healthcare appointments, however guidance from health professionals was not routinely available in care records. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

We received mixed reviews about the care and support which people received. Some people told us missed and late calls impacted upon the quality of their care and this had not always provided them with a good experience of the service. Some people told us their privacy and dignity had been impacted at times, which we deemed to be a training issue. Other people spoke positively about the quality of care which they received from care staff and told us care staff were kind and friendly but felt that changes needed to be made in the office to improve their overall quality of care. People had not been routinely involved in planning and reviewing their care. Some people using the service did have access to advocacy services.

Care records did not contain the information needed to provide safe care to people which was in line with their needs wishes and preferences. People were supported to attend day centres, activities of daily living and areas of interest in line with their agreed care packages. The provider had identified that complaints had not been investigated and dealt with as they would have expected and changes had been made to address this. No-one was receiving end of life care during this inspection.

At the time of inspection, the service was under significant pressure. The regional manager was open and honest about the position of the service and had started to make improvements. Recruitment was ongoing in all areas; some training had been put in place. The number of office based staff had increased which provided additional oversight of care packages. This had started to reduce the number of missed and late calls. Staff told us they were committed to staying with the provider. Safeguarding alerts and notifications had been submitted without delay.

The provider was working with Stockton-On-Tees local authority to make improvements and had agreed to hand care packages back to them to reduce existing pressures on the service. The provider had made the decision to withdraw from its contractual arrangements with Redcar and Cleveland local authority and were working through this at the time of inspection.

An acting manager and regional manager were in place during the inspection. A critical review of the service had taken place. This audit had identified multiple areas where improvements were needed. The provider had devised an action plan from these findings and was also using information from the local authority commissioners visits to ensure all areas for improvement were addressed. The senior management team had prioritised the order in which these issues would be addressed with high risk areas being resolved first.

When we visited, the provider had started to make improvements and had started to reduce risks by employing additional staff, training the staff team, implementing safeguarding procedures, ensuring staff safely assisted people to move, and reviewing medication practices. However, these actions had been recently introduced so were not embedded.

We found multiple breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to requirements relating to safe care and treatment, good governance and staffing. We also identified a breach of the Care Quality Commission (Registration) Regulations 2009 for failing to submit notifications without delay.

You can see what action we told the provider to take at the back of the full version of the report.

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.”

Castlerock Recruitment Group (CRG) provides personal care and support for people in their own home. At the time of our inspection 32 people were receiving personal care and support from the service. At the last inspection, in May 2015, the service was rated good. At this inspection, we found the service requires improvement.

People continued to receive safe care and support. They were protected from abuse and avoidable harm by staff who knew their responsibilities to follow the provider's procedures. Risks to people's well-being were assessed and monitored. However the registered manager did not always provide guidance to staff to help people to remain safe.

Where people required assistance with their medicines, this was undertaken safely by staff who knew their responsibilities. However medicine records were not always correct.

The provider had safely recruited a sufficient number of staff to meet people's care requirements. Staff files were inconsistent with items missing. We found these items were waiting to be filed.

People continued to receive care from staff that had the necessary skills and knowledge. Staff were trained and received on-going support so that they understood their responsibilities. People were offered food and drink based on their preferences and supported to maintain good health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service provided guidance in this practice.

People continued to receive compassionate care from staff members who protected their dignity and privacy. Staff knew the people they supported and could easily explain people's life history and background, however not all this information was recorded. People were involved in decisions about their care and their independence was promoted wherever possible so that they retained their skills.

People continued to receive care and support based on things that mattered to them. People’s care plans did not reflect people’s current needs. Staff we spoke with were fully aware of any updates however these had not been recorded. When care plans were reviewed and people's needs had changed the care plans were not updated to reflect these changes.

People and their relatives knew how to make a complaint and there were clear procedures in place to handle them should one be received.

Staff we spoke with said the registered manager had an open ethos that encouraged feedback. Staff were supported well by the registered manager and received feedback on their work. The registered manager was aware of their responsibilities.

The registered manager carried out a range of quality checks to make sure the service was delivering a high quality service. However the quality checks did not reflect the lack of updated records.

Further information is in the detailed findings below. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

People who used the service and their relatives had no concerns about the care the service delivered. They thought that staff were knowledgeable and made sure that people were safe. Pre admission assessments and risk assessments had been carried out and care plans had been written to ensure staff knew how to keep people safe.

The provider had systems in place to reduce the risk of abuse and staff had undergone training make sure they were aware of their responsibilities if they had concerns that abuse was taking place. Some staff weren't aware of how safeguarding concerns were investigated outside the organisation or that the Local Authority lead safeguarding investigations.

People who used the service were supported by staff who had undergone a recruitment process which ensured that pre-employment checks were carried out and that staff were suitable to work with vulnerable adults.

The provider had systems in place to check the quality of the care it delivered however during our inspection we were only able to find limited evidence that all of these checks had been carried out regularly and frequently.