Archived: CRG Homecare Lincolnshire

Updated 6 November 2021

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 Care Act 2014.

Inspection team

The inspection team consisted of one inspector and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. This service also provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

The service does not currently have a manager registered with the Care Quality Commission. However, there is a new manager in post and they are in the process of applying to register as manager.

Notice of inspection

We gave a short period notice of the inspection so we could arrange to speak with staff and clients before visiting the office.

Inspection activity started on 26 May 2021 and ended on 02 June 2021. We visited the office location on 2 June 2021.

What we did before the 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. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 20 people who use the service and 24 relatives. We also spoke with seven members of staff, the manager and the provider’s head of quality and governance. We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 6 November 2021

About the service

CRG Homecare Lincolnshire provides personal care to people living in their own home. The service was providing support for approximately 250 people living in and around Boston and Sleaford in Lincolnshire. Some of the people were living in two extra care housing apartment complexes one in Boston and one in Sleaford.

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 received a different level of service dependant on where they lived, with people living in and around Sleaford being mainly happy with the care provided. However, people in the Boston area received a poor quality of care. There were not enough staff to meet people’s needs and call times were inconsistent and not in line with people’s wishes. People’s choices over gender of staff were not always supported.

The provider’s systems to monitor, and drive improvements in the quality of care were ineffective. Lessons were not being learnt when incidents happened, or complaints were received. Communication with people using the service and relatives was inconsistent.

People received care from multiple members of staff and felt this impacted on their care as they were unable to develop trusting relationships with staff. Where people did get to know staff, they felt that staff were caring. Medicines were not always safely managed. Specific guidance on the safe administration of medicines was not always followed. Appropriate checks were completed before staff began work at the service.

Staff training had not been kept up to date and staff had not always been supported with spot checks and one to one supervision with their manager. People’s care plans were not always developed in a timely fashion and had not been reviewed on a regular basis in line with the provider’s policy. People were not always able to eat at a time which suited them due to inconsistent call times. Staff raised concerns to healthcare professionals when people were unwell.

People were not supported to have maximum choice and control of their lives. However, staff did support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not always support this practice. This was because people did not always receive their care at a time of their choice.

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 requires improvement (published 28 January 2021) and there were multiple breaches of regulation. A warning notice was issued telling the provider they needed to improve their service. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to there not being enough staff to meet people’s needs at the time they requested. That risks around the administration of medicines were safely managed and the systems in place to manage the service were ineffective.

We imposed a condition on the provider's registration to drive improvements in care.

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