The inspection took place over the period of 14 February 2018 to 26 February 2018, with the registered provider being given short notice of the visit to the office in line with our current methodology for inspecting domiciliary care agencies. The service was last inspected in July 2017, and was given an overall rating of “requires improvement.” Five breaches of regulations were identified at that inspection, relating to; how the service was managed and the governance arrangements; how medicines were managed; how consent was obtained and acted upon; a failure to notify the Care Quality Commission (CQC) of specific incidents where required; and a failure to display their CQC rating. At our inspection of 14 February 2018 to 26 February 2018 we found the registered provider had failed to act on the findings of the previous inspection and address all the breaches of regulation identified at that inspection.
Care Assistance is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults. At the time of the inspection the registered provider could not tell us precisely how many people they were providing personal care to, but told us they thought it was “about 80.”
The provider was registered as an individual, meaning that there was no requirement for a registered manager.
People using the service told us they found staff to be caring, telling us they had a good relationship with the staff who provided care for them. However, they told us that at times care calls could be late. A small number of people told us there had been missed care calls in the past.
People’s medicines were not appropriately managed, with staff at times administering medicines that were not supported by records. Risk assessments lacked detail and did not give sufficient information about how staff should act in order to manage and minimise risks.
The registered provider did not have appropriate arrangements to ensure they complied with the Mental Capacity Act 2005 (MCA.) People’s consent was not always lawfully obtained, and where people lacked the mental capacity to give consent to their care, the correct steps were not followed.
The registered provider had a complaints policy in place, but did not follow this policy when addressing complaints.We saw incidents of complaints not being appropriately investigated or responded to.
The registered provider was failing to carry out sufficiently robust audits to ensure that shortfalls or concerns were identified and addressed. The registered provider did not have a system in place to monitor the quality of service provided, and could not evidence that it was complying with the law in this area.
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.
You can see what action we told the provider to take at the back of the full version of the report. We are taking enforcement action against the provider, and will report on this at a later date.