20 September 2022
During an inspection looking at part of 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.