Archived: Global Care Ltd

Updated 25 February 2023

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 Health and Social Care Act 2008.

Inspection team

Two inspectors carried out the inspection.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses. This service was also registered to provide care and support to people living in ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the inspection the service was not providing this type of care.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection on the first occasion we announced the inspection. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection. However, the service did not respond and did not ensure staff were at the office premise. We gave the service seven days’ notice the second time we announced our inspection to ensure staff would be available.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

One person was using the service at the time of our inspection and we spoke with their relative. We spoke with the only care assistant employed by the service, an external consultant and their assistant and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We asked for a list of operational staff and their contact details to speak with, however this was not provided by the nominated individual.

We reviewed available records at the office location. This included policies and procedures, staff files, risk assessments and a person’s care plan. Not all the information we required was available during our site visit and we asked the nominated individual to provide this electronically after our inspection. However, the service did not submit this evidence.

Updated 25 February 2023

About the service

Global Care Limited is a domiciliary care agency registered to provide personal care and support to people in their own home and supported living services. The service was not specifically for people with a learning disability and/or autistic people, however at the time of our inspection the only person using the service had these needs. The service had not commenced providing personal care to people in supported living settings.

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

Systems to protect people from abuse were not implemented. Staff were not trained on how to recognise and report abuse and staff recruitment checks were not carried out prior to supporting people.

Staff skills were not matched to people’s needs and mandatory and specialist initial and refresher training was not arranged by the provider. Staff were not trained to administer emergency medicines which put the person at increased risk of harm. Systems were not in place to protect people from the risk of infection. For example, staff did not use personal protective equipment (PPE) effectively and safely.

Initial assessments to identify people’s needs and risks were not completed prior to care commencing. Care plans were not in place to provide staff with guidance about how to support people according to their needs and preferences.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Senior staff did not understand or demonstrate compliance with regulatory and legislative requirements. The management of people’s records did not ensure they were protected and stored safely. The service did not complete audits or checks to monitor the quality and safety of care provided.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Care plans were incomplete and did not contain enough information about how to support people.

Right Care:

People were not always supported with care that was person centred and promoted people's dignity, privacy and human rights. The service failed to ensure there were enough appropriately skilled staff to meet people's needs and keep them safe.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services led confident, inclusive and empowered lives. The service failed to evaluate the quality of support provided to people or ensure risks of a closed culture were minimised.

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 8 March 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the governance of the service including not meeting the conditions of registration. A decision was made for us to inspect and examine those risks. We also undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Global Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, safe care and treatment, dignity and respect, consent to care, safeguarding service users from abuse and improper treatment, notifying the Commission of change and incidents, receiving and acting on complaints, good governance, staffing and fit and proper persons employed.

Please see the action we have told the provider to take at the end of this report.

We took urgent action to place restrictions on the provider's registration which involved stopping any new admissions to the service. We took action to cancel the provider's registration, so they are no longer registered to provide the regulated activity personal care.

Since the last inspection we recognised that the provider had failed to display their rating. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains 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.