We undertook an announced inspection of Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 14 and 21 June 2018. We told the provider three days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people. Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London is a domiciliary care agency that provides personal care to around 89 people in their own homes in the London Borough of Ealing and 18 people living in the London Borough of Brent.
We previously inspected Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 4 and 5 October 2017 and we identified issues in relation to safe care and treatment (Regulation 12), need for consent (Regulation 11), good governance (Regulation 17) and staffing (Regulation 18). The provider was rated inadequate in the key questions of Safe and Well-led and overall. As a result, the service remained in Special Measures.
At the time of this inspection a registered manager was in post. The registered manager was also a company director. 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 a medicines policy and procedures but medicines for some people were still not managed or administered appropriately as information was not provided for care workers as to how the prescribed medicines should be administered.
Improvements had been made in relation to risk management plans but there was no process for assessing the levels of risk to people’s safety and wellbeing and recorded assessments indicated that all risks were ‘low’ regardless of the seriousness and impact of the particular risk. As a result, the provider did not ensure that appropriate action were in place to mitigate risks according to the severity.
The visit times identified in the agreed care plans did not always reflect those shown on the care worker rota. Therefore, people did not receive care at the times which had been planned meaning that there was a risk that their needs were not being met according to their preferences and wishes.
The provider's mental capacity assessment process was not sufficient because it did not relate to the ability of the person to make decisions in relation to a specific aspect of the care they received and their daily life. Where a relative or representative consented to care being provided it was not clear if the person receiving support did not have the mental capacity to consent to their own care and if the relative had the legal right to make these decisions in the person’s best interests.
The provider's assessments of staff competency in relation to moving and handling and medicines management did not provide appropriate information to demonstrate that care workers were competent in these areas or had sufficient knowledge.
The provider did not always learn lessons, identify themes and act to improve safety for people using the service as their quality monitoring system did not always identify areas for improvement. The information recorded when a visit occurred either earlier or later than planned but the care provision was not reviewed to identify if any changes were required to the visit time agreed with the person or if the care worker had been given enough time to complete their rota.
Records relating to people using the service did not always provide accurate information relating to the care and support they needed.
Improvements had been made to the recording and review of incidents and accidents. Care workers were allocated visits on their rotas with travel time and the visits did not overlap.
The provider had a clear recruitment process in place.
The provider completed assessments of people's support needs before care was provided in their home.
Care workers had completed the Care Certificate and training identified as mandatory by the provider.
We received mixed feedback from people with the care they received with some people telling they were happy whilst other people identifying times when they were not happy.
People told us the care workers were kind and caring and treated them with dignity and respect when providing care. The care plans identified each person’s cultural background, personal history and any religious beliefs.
Care plans identified how the person wanted their care provided including their likes and dislikes. People knew how to make a complaint and provider had followed their complaints procedure.
People told us that in general they felt the service was well-led but they did provide some examples when it was not.
We found four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to safe care and treatment of people using the service (Regulation 12), the need for consent (Regulation 11), good governance of the service (Regulation 17), staffing (Regulation 18).
We are taking action against the provider for failing to meet regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
The service has been in special measures and has been inspected within six months as we state in our guidance. As insufficient improvements have been made and there remains a rating of inadequate for the key question of well-led the service therefore remains in special measures.
Services in special measures are 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.
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.