This inspection took place on 8 and 16 February 2017 at the registered location office and we subsequently carried out interviews with staff and spoke with people via telephone on 3 and 6 March 2017. We also visited people in their own homes on 21 February 2017. Castle Care provides personal care to people living in their own homes in and around the Barnard Castle area. There were currently 72 people using the service.At the last inspection on 16 and 19 September 2016 we rated the service as “Requires Improvement.” The service has not been compliant with regulations since our inspection in 23 and 28 July 2015. We had issued a warning notice to Castle Care Teesdale Limited on 13 October 2016 where the service was required to be compliant with regulations by 31 January 2017.
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.
The service had 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.
We checked to see if people were given their medicines in a safe manner and found there were gaps in the Medicine Administration Records (MAR). We saw that not all people had a list of medicines in their dosette boxes so staff knew what they were supporting people to take. Not all staff had training in the safe administration of medicines. This put people at risk of not receiving their medicines safely.
Risk assessments were not in place to ensure people were kept safe. People who required restrictive equipment such as bedrails did not have specific risk assessments in place. This meant staff did not always have the guidance in place to help them mitigate the risks to people using the service. We saw one person had a serious incident with a bedrail that was not followed up or reported to the relevant authorities by the registered provider.
There was not a systematic method of recording incidents. We found incidents had not been reviewed in sufficient detail to ensure people who used the service were kept safe. CQC requires registered services as a part of their registration to notify the Commission when there are incidents of a safeguarding nature, people receive injuries or there is a death of someone using the service. We found no notifications had been made to CQC since the service registered with us in 2010.
The registered provider did not carry out comprehensive pre-employment checks to ensure staff were safe to work with vulnerable people.
Staff were not supported to carry out their role through regular supervision and appraisal. We found staff were caring for people without having had training to meet people’s needs. For example we found no staff had received training in diabetes or catheterisation. Some staff members had not received training in mandatory areas such as safe handling and administration of medicines, food hygiene, safeguarding and health and safety. Induction training could not also be fully verified for new staff which meant people were at risk of receiving care from staff who were not trained.
We saw the service had now sought the written consent of people using the service.
Assessments were not always carried out with people prior to them receiving the service. We found two people without assessments and care plans in place. This meant that people were at risk of receiving unsafe care.
We found people with specific needs such as diabetes or were at risk of choking did not always have care plans in place to ensure staff were given guidance on how to care for people. This meant people could be at risk of receiving unsafe care.
There was a lack of established quality audits carried out at the service by the registered manager and director. The service had implemented some spot audits to visit people at home and observe staff but this had not commenced until January 2017. There were still no mechanisms for reviewing medicine administration records which meant gaps we found had not been picked up and addressed.
Management systems such as policies and procedures were not shared with staff, and although staff told us they felt supported by the registered provider and registered manager, there were not systems in place to share service updates via staff meetings as these did not take place.
We did see that the registered manager had begun to carry out care plan reviews. These had not taken place systematically previously.
Care plans were not person centred and did not reflect the views and preferences of people who used the service. We found care plans were a list of tasks to be carried out by care staff.
The service did not have an established complaints process in place and we saw complaints had not been dealt with according to the registered provider's own policy on receiving and responding to complaints.
Feedback from people who used the service at Castle Care was positive about the care and support they received from staff.
During our inspection we found a number of continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Details of any enforcement action taken by CQC will be detailed once appeals and representation processes have been completed