26 April 2021
During an inspection looking at part of the service
Leader Care is a domiciliary care service. It is registered to provide personal care to people living in their own homes in the community.
Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection, three people were receiving a personal care service.
People’s experience of using this service and what we found
The provider was failing to effectively assess, monitor and improve the quality and safety of the service and to assess and manage a range of potential risks to people's safety and welfare. The leadership, management and governance arrangements did not provide assurance the service was well-led. Quality assurance and governance arrangements had not been reliable or effective in identifying shortfalls in the service.
Information relating to people's individual risks were not always recorded or mitigated and did not provide enough assurance that people were safe. Suitable arrangements were not in place to always ensure the safe management of medicines and this placed people at risk of harm.
Lessons were not consistently learned to improve the quality of care for people using the service. The provider's response to the COVID-19 pandemic was inconsistent and increased risks to people's health. Appropriate measures were not in place to prevent and control the spread of infection.
Recruitment procedures were not always robust enough to ensure suitable people were employed. Staffing levels were maintained. However, changes to calls were made without discussion with people and there was no analysis of missed or late calls to prevent them happening again.
A person and a relative we spoke with were satisfied with the care and support they or their family member received from individual staff. They described staff as kind and caring. However, they said arrangements to communicate with them were not effective; for example, they did not know which staff were coming to provide their care. Care plans covered people's individual care and support needs. Improvements were still required to ensure each person's care plan was up to date and accurate.
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 Inadequate (published 17 December 2020) and there were multiple breaches of regulation. The provider told us after the last inspection what they would do to improve. At this inspection we found insufficient improvement had been made and the provider was still in breach of regulations.
Why we inspected:
This was a planned inspection due to an increasing number of concerns being raised with us about the safety, management and leadership of the service and to follow up on action we told the provider to take at the last inspection. The inspection was focused on the key questions of Safe and Well-led. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Leader Care on our website at www.cqc.org.uk.
The overall rating for the service remains Inadequate. This is based on the findings at this inspection.
Enforcement:
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
At this inspection we have identified continued breaches of regulations in relation to the assessment and management of potential risks to people's safety; medicines management; infection prevention and control; recruitment; staffing; governance and leadership of the service.
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:
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
Special Measures:
The overall rating for this service is ‘Inadequate' and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the registered person's registration, we will re-inspect within 6 months to check for significant improvements.
If the registered person 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 registered person from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of 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 re-inspect it and is no longer rated as Inadequate for any of the five key questions, it will no longer be in special measures.