Archived: Shropshire, Crewe

Updated 26 November 2020

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

Service and service type

This service is a domiciliary care agency that provides nursing and personal care to people living in their own homes. At the time of the inspection there were 8 people receiving a service according to the provider although later evidence suggested there were more.

The service had a registered manager, who was also the provider registered with the Care Quality Commission. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 19 hours’ notice of the inspection. This was because we needed to be sure that the provider would be in the office to support the inspection.

Inspection activity started on 26 September 2019 and ended on 16 October 2019. We visited the office location on 26 September 2019.

What we did before the inspection

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 looked to see what information we held about the service to plan the inspection. This included checking for any statutory notifications that the provider had sent to us. A statutory notification is information about important events which the provider is required to send us by law. We had not received any.

As part of the inspection we spoke with one representative of a person who used the service to establish their views and feedback about the service provided. We requested contact details of people who used the service, but the provider was not able to gain people’s consent to share these with us. We spoke with three staff who contacted us following the office visit.

During the inspection

During the inspection we visited the office location however there was only very limited information/ documentation available to review. We spoke with the provider who said they would provide required information immediately following the inspection.

Following the inspection, we continued to request information formally, but we did not receive the majority of what we requested. We did however receive two care plans, a list of staff training and details of complaints and investigations.

Updated 26 November 2020

About the service

Shropshire, Crewe is a domiciliary care agency that provides personal care and nursing care to people in their own homes. At the time of the inspection the agency was not providing nursing care.

At the time of the inspection the provider told us there were eight people receiving personal care at the end of their lives. However, later evidence suggested there were more.

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

People who used Shropshire, Crewe did not receive a safe, effective, caring, responsive or well led service. The provider was unable to demonstrate the safe and effective running of the service as records were either unavailable, illegible or disorganised. We were unable to seek people’s views directly as the provider had not sought appropriate consent for us to contact people and we had been advised that staff would not share contact details with us.

People were not safeguarded from the risk of abuse because the provider could not demonstrate staff were either trained or informed to recognise the potential signs of abuse. There was no evidence that incidents of potential abuse had been referred to the local authority safeguarding team or investigated adequately by the provider. The provider’s poor documentation meant they could not demonstrate changes had been made to protect people from possible abuse.

Due to the lack of information provided to us, the provider could not demonstrate staff supported people to receive medicines safely and this placed people at risk of harm. Information was not available to support staff to administer safely and records were not accurate. Staff had not received training to administer medicines safely or had their competency checked.

People did not always have risks to their personal safety identified. When they had been identified, control measures were not in place or were contradictory, therefore risks were not mitigated.

The provider could not demonstrate staff had been recruited safely. Recruitment files seen were incomplete, illegible or inaccurate. We could not be assured who was currently employed by the provider or what checks had been made before employing them.

Although one person’s representative told us that staff were polite and courteous, people were not cared for by staff who had the necessary skills and were not supported in their role by the provider.

Care plans were not consistent to show how people’s support needs should be met and information required to ensure staff delivered effective care was not available. People did not always receive care and support at times agreed and this affected the quality of care provided and people’s safety. Care plans did not detail changes or updates, just basic care information.

There was no evidence of people’s capacity to make decisions being assessed or evidence of how the agency worked effectively with outside agencies, including health care professionals.

People’s private information was not protected in line with data protection legislation and people were not always satisfied with the care provided. The provider could not evidence they provided a responsive service.

Where people had complained about the quality of the care their received it was not evident the provider had responded to ensure changes were made as a result.

The provider told us the service ‘specialised’ in end of life care. Staff had not received training to support people at the end of their life and plans of care were not specific about people’s needs and wishes at this time.

The service was not well led. The provider had failed to notify appropriate agencies, including CQC of safeguarding concerns and they failed to provide us with information in a timely manner. Some information requested formally following the inspection was not provided. Staff did not feel supported or that their views were listened to. There was no evidence that people had been consulted about the care they received.

Why we inspected

This was an inspection brought forward after concerns were shared with us by a local authority quality assurance team

Rating at last inspection

The was the first inspection of the service since registration in March 2019.

Enforcement

We have identified breaches in relation to the safe recruitment of staff, safe care and treatment, staffing, safeguarding people from abuse, person centred care, complaints monitoring and in the governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections 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.'

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.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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