The Care Bureau Domiciliary and Nursing Agency Kettering

People's experience of using this service and what we found.

Enough staff were employed to meet people's needs. In most cases, timely calls and calls of assessed need were in place to provide personal care, though this was not always the case

Evidence of follow up to concerns or complaints were not always in place, though this had improved recently.

A person provided with personal care, and relatives we spoke with, were positive about the care that staff provided and with the management of the agency.

Safe care was provided, with protection against abuse, neglect and discrimination.

Details of how to reduce risks to people's safety were included in people's care plans. Care plans reflected people’s individual needs.

Safe recruitment practices were in place to ensure only suitable staff worked at the service.

Quality assurance systems were in place to try to ensure people were provided with a quality service.

The regional manager understood their responsibilities and worked in an open and transparent way.

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

Rating at last inspection

The last rating for this service was good (published 17 July 2018).

Why we inspected

We received concerns in relation to unsafe care being provided, untimely calls and concerns regarding the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. 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 as good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Care Bureau Kettering on our website at www.cqc.org.uk.

Follow up

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

The Care Bureau Domiciliary and Nursing Agency Kettering is a domiciliary care agency providing personal care to people in their own homes. At the time of inspection, the service was supporting 70 people.

Not everyone who used the service received personal care. 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.

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

People were supported to access a COVID-19 test when displaying symptoms.

People told us that staff wore appropriate PPE when supporting them.

The provider had clear policies and procedures in place for staff to follow for infection prevention and control and the use of personal protective equipment (PPE).

Staff were trained in preventing infection and control. Staff competency in following safe infection control practices had been regularly checked.

Staff had access to regular testing for COVID-19 and considerations had been made for staff who were deemed at higher risk of COVID-19.

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

Rating at last inspection

The last rating for this service was good (published 17 July 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about infection prevention and control. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Care Bureau Domiciliary and Nursing Agency Kettering on our website at www.cqc.org.uk.

Follow up

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.

When we inspected again on 28 February and 1 March 2017, we found improvements had been made but we needed to be assured that these had been sustained and embedded into practice. We found that safeguarding investigations allocated to the provider to follow up prior to our inspection had not always been satisfactorily completed. This was a breach of regulation 13(3) of the HSCA 2008 (Regulated Activities) Regulations 2014, Safeguarding service users from abuse and improper treatment. The provider had also been in breach of Regulation 17 (1) (2) (a) of the HSCA 2008 (Regulated Activities) Regulations 2014, Good Governance. This was because we found that the systems adopted by the provider to monitor the quality of care that people received had not consistently been effective.

At this inspection in May and June 2018 we saw that all the improvements had been sustained and that the provider had taken timely and appropriate action and was no longer in breach of the above regulations.

There was a registered manager in post. 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.

The service met all relevant fundamental standards related to staff recruitment, training and the care people received. People’s care was regularly reviewed with them so they received the timely support they needed. Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation.

People were cared for by staff that knew what was expected of them and the staff carried out their duties effectively. Staff were friendly, kind and compassionate. They had insight into people’s capabilities and aspirations as well as their dependencies and need for support. They respected people's diverse individual preferences for the way they liked to receive their care.

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 supported this practice.

People that needed support to manage their medicines received this. People were supported to eat and drink whenever this was part of their agreed plan of care.

The provider and registered manager led staff by example and enabled the staff team to deliver individualised care that consistently achieved good outcomes for all people using the service.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and any improvements identified were worked upon as required. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong so that the quality of care across the service was improved.

People, relatives and staff were encouraged to provide feedback about the service and this was used to drive continuous improvement. The provider had quality assurance systems in place that were used to review all aspects of the service and drive improvements whenever needed.

People how to complain and were confident that if they had concerns these issues would be dealt with in a timely way.

There was not a registered manager in post. 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.

The provider had not maintained adequate oversight of the care and support that people received. Shortfalls in the service that people received from the Care Bureau had not been identified by the provider in a timely manner because the quality assurance systems utilised were not effective. During this inspection the provider outlined their plans to adopt a more robust system of quality assurance however, this had not yet been embedded in practice.

Care staff continued to feel under pressure because their schedules did not make allowances for travel time. The time taken by care staff to travel between care calls had been considered by the provider when developing staff schedules however, care staff had not been communicated with effectively and did not understand that the time shown on their schedule provided a 30 minute window in which they should arrive to people to provide their commissioned care.

Care staff felt under pressure to provide people’s care quickly in order to travel to and arrive to provide other people’s care on time. This had impacted upon some people’s experience of receiving care and support and meant that staff could not engage in a consistently positive manner with people receiving care and had created a task led culture amongst some care staff.

People could not be assured that their complaints would be responded to appropriately and improvements were required to the way in which feedback from people was managed.

People’s care records contained risk assessments and risk management plans to mitigate the risks to people. These plans gave clear instructions to staff on how to minimise the identified risks. People’s needs had been assessed and detailed plans of care had been developed to guide staff in providing care in partnership with people who used the service.

People’s health and well-being was monitored by staff and they were supported to access relevant health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to help maintain their health and well-being.

At this inspection we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.

The Care Bureau is registered with the Care Quality Commission (CQC) to provide personal care to people living in their own homes. At the time of the inspection The Care Bureau was providing care and support to 223 people totalling 1700 hours of care and support each week.

There was not a registered manager in post however the provider had recruited a new manager who told us that they would submit an application to CQC to become the registered manager. 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.

There was a systematic failure in the leadership and governance of the service which had resulted in safe systems of care failing to be implemented consistently. People were exposed to the continuing risk of harm because the provider had not taken action to assure themselves that people were receiving safe care and support. There were insufficient resources available to coordinate people’s care and support consistently or safely.

People were not protected from harm because procedures and processes which protect people from potential abuse, by ensuring safeguarding matters are responded to appropriately had not been implemented. Staff had failed to recognise incidents which should be reported to the safeguarding team, investigate incidents or to take appropriate action to mitigate the risks to people

People had not always received their planned calls or calls were late resulting in missed and late medicines for people. People could not be assured that they would receive their medicines. Records of the medicines that people had been administered were not completed appropriately and systems had not been implemented to audit people’s medication administration records and investigate potential medicine errors.

Staff providing care and support did not have the skills and knowledge that they required to care for people safely. Staff did not apply the training that they had received on a day to day basis and training in key areas was not refreshed.

People could not be assured that they would receive adequate food and nutrition. People who required support to prepare their meals did not always receive them because staff did not turn up or they were late The provider had failed to implement systems to identify and resolve missed or late calls to people.

People could not be assured their complaints would be managed effectively or that the provider would learn from people’s feedback and implement improvements. Systems were not being operated to manage, respond to and resolve people’s complaints. We found numerous examples of people making complaints that had not been acknowledged by the provider.

People’s individual plans of care were not reflective of their current care needs. People received inconsistent levels of care and support that was not provided according to their individual preferences.

There was a lack of leadership, governance and managerial oversight of the service. There was a systematic failure to implement any of the provider’s procedures for quality monitoring. This had resulted in the shortfalls highlighted in this inspection failing to be addressed adequately by the provider and placed people at the continuing risk of harm.

At this inspection we found the service to be in breach of eight regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 and one regulation of the Care Quality Commission (Registration) Regulations 2009. The actions we have taken are detailed at the end of this 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.

We spoke with members of staff who told us training was, 'very good' and gave them a good understanding of how to meet people's needs and what to do if there were any problems.

We also spoke to people who used the service and they told us, 'I am very pleased with them.'

We looked and the Provider's policies and procedures for Safeguarding, and for Quality Assurance. We found that the policies in place meant that services were reviewed regularly and any concerns were managed appropriately. We also found that the Provider had appropriate arrangements in place for the recruitment and support of staff.