Archived: CRG Homecare Workington

We saw that since our last inspection significant work had taken to improve the safety and quality of the service and found no breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the provider had complied with the warning and requirement notices in relation to the previous breaches. However, we did find some areas still required to improve and be sustained to ensure a consistent delivery of safe care and treatment. We found sufficient improvements had been made that the service is no longer in special measures.

CRG Homecare Workington domiciliary care agency is based in the town of Workington. It offers a range of services for people living in their own homes. The agency provides support with personal care and domestic tasks to help in maintaining independence for people in their own homes in the town and the surrounding rural areas of Copeland and Allerdale.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the (CQC) 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.

When employing fit and proper persons the recruitment procedures of the provider had usually been followed. However we saw for two people who had been recently employed the checks about the reasons for leaving their previous employment had not been completed.

We have made a recommendation that the provider ensures that all the checks of suitability are completed for each employee. In addition, that the registered manager completes checks or audits to ensure the recruitment process has been completed in a robust way.

We observed that people received their medications in the appropriate way and were recorded. However, we found that written information about the level of support people required with their medications was not always clear. We discussed the clarity of records relating to the level of support people required during the inspection with the provider’s quality manager and registered manager and they confirmed the records would be reviewed.

We found that risks associated with bedrails that were in use in people’s homes had not been identified or recorded. The provider’s quality manager took immediate action to address this during the inspection.

We have made a recommendation that the provider review their policy and care records used for the safe use and management of bedrails.

Staff told us they received training on a variety of subjects. Records we saw showed staff had completed training that enabled them to improve their skills in order to deliver care and support safely.

There were sufficient numbers of suitably qualified staff available to meet the needs of the service and recruitment by the provider was ongoing. However some people who used the service expressed they did not always have the consistency of regular carers. The feedback we received from people who used the service and their relatives was that care workers arrived on time, remained for the whole allocated time for the visit and care workers completed all of the required tasks

People were supported to maintain good health and independence in their own homes. We saw that appropriate referrals to other healthcare professionals were made in a timely manner.

The provider had been responsive in improving systems of recording information about most people’s needs and the planning of their care. Records had been reviewed to ensure accurate details about the changing needs of people were available to the staff looking after them. However, we saw that some records still needed to show that they were being consistently reviewed when needs had changed.

People who were supported by the agency and their relatives that we spoke with gave mixed views of the services they received. However, we were also told that people had experienced a definite improvement in their service since the last inspection and appointment of the new registered manager.

Where safeguarding concerns or incidents had occurred these had, in the main, been reported by the registered manager to the appropriate authorities and we could see records of the actions the agency had taken to protect people. Since the last inspection changes had been made to improve the oversight of the quality of the service by the provider in the appointment of a Quality Assurance Manager.

CRG Homecare Workington delivered domiciliary care to adults in the Copeland, Allerdale and Carlisle areas. The company won the tender to provide care on behalf of Cumbria County Council and started to deliver care in February 2016. The service was registered in April 2016. At the start of the week beginning 31 October 2016 203 hours of care and support were delivered in Carlisle and 808 in Allerdale and Copeland combined. There were 113 service users and 48 staff, delivering care throughout the area every day of the year.

The head of operations had been registered as the manager of the service as an interim measure until a locally based manager could register. Two previous branch manager had not registered. The service had a new branch manager who was in the process of applying to register as the 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.

Suitable arrangements were in place so that staff could identify and report any safeguarding incidents. Not all matters of safeguarding had been reported to the Care Quality Commission. We made a recommendation that senior staff received further training about managing safeguarding.

Risk assessments had been done and some had been recently updated. We have made a recommendation that all risk assessments were reviewed to ensure that risks continued to be reduced.

We found a number of issues around recruitment and disciplinary matters that might have put vulnerable people at risk. This was a breach of Regulation 19 of the Health and Social Care Act 2008; Fit and Proper Persons employed because appropriate background checks were not in place for some staff. Concerns about fitness and ability to carry out duties had not been dealt with appropriately.

We judged that the service had not always been well staffed but we saw that efforts had been made to recruit enough staff. We have made a recommendation that the provider review their recruitment and retention of staff procedures.

We found that medication administration had not been done correctly in some homes. This is a breach of Regulation 12 of the Health and Social Care Act 2008: Safe and care treatment because the provider had failed to ensure the proper and safe management of medicines.

Staff had received suitable levels of initial training but their competence had not been checked in the delivery of care and support. Supervision and observation of practice had not been completed routinely. This was a breach of Regulation 18 of the health and Social Care Act 2008; Staffing because the provider had failed to ensure that staff were competent, skilled and experience to deliver good standards of care.

We had some evidence to show that communication within the team and with other professionals had not always been good. We saw that steps were in place to improve this but we made a recommendation that this continues to be reviewed so that lines of communication continue to improve.

We saw evidence to show that people had been consulted about consent to care and that the new manager was ensuring that everyone they supported understood this. We were informed that no one was being deprived of their liberty because of any actions taken by the provider.

We saw that staff had training on nutrition and hydration and that the service did not have any complex work around this need. We recommended that the service look at more in-depth understanding of hydration and nutrition so that they could meet these needs if necessary.

Staff understood their responsibilities in supporting people to get the right kind of health care support.

The office was suitable as a base to run the service. The provider had a small satellite office in Carlisle so that staff did not have to travel to Workington.

We had responses to our surveys and telephone calls that indicated that most staff were caring. We had further evidence to show that late, shortened or missed calls had compromised the dignity of individuals. This was a breach of Regulation 10 of the Health and Social Care Act 2008;Dignity and respect because the delivery of care did not always ensure that people were treated in a caring and compassionate way.

Assessment and care planning was not up to date. The care delivery had not been analysed on a routine basis. Some houses had no care plans in place. This was a breach of Regulation 9 of the Health and Social Care Act 2008: Person centred care because the provider had failed to fully assess people's need and care planning and review were not being completed adequately so that safe care and treatment was provided.

The company had a suitable complaints procedure. The procedure had not always been followed but the registered manager and the provider were ensuring that any outstanding responses were dealt with. We have made a recommendation that the provider continues with this and contact any person where a complaint had still not been resolved.

The provider had a detail and suitable quality monitoring system but this had not been followed in the service. We saw that in the last month or two some progress had been made by the area manager and by the new branch manager. We also had evidence to show that the monitoring of quality in relation to care planning, recruitment, supervision and the deployment of staff had not been monitored closely. Quality improvements had only started to be made. Records were not well kept.

This is a breach of Regulation 17 ;Good governance because quality monitoring systems and processes had failed to assess, monitor and improve the quality and safety of the service.

We also had evidence to show that the provider had failed to notify the Care Quality commission of events in the service. This is a breach of Registration Regulation 18: Notification of other incidents. We will be taking further action separate from this inspection.

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.