We carried out this inspection on 7 and 8 November 2018. This inspection was announced, which meant the provider was given 48 hours’ notice of our inspection visit. We did this because the service is small and the manager was sometimes out of the office and we needed to be sure that they would be available. We also wanted to arrange to visit some people using the service. The Caring Choice Ltd is a domiciliary care agency. It provides support to people living in their own houses and flats in the community. Not everyone using The Caring Choice Ltd receives support with the regulated activity of ‘personal care’; The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At time of this inspection The Caring Choice Ltd was providing support to 41 people.
At our last inspection on 10 and 13 November 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulation 17, Good governance, Regulation 18 Staffing and Regulation 19, Fit and proper person employed. The overall rating of the service was requires improvement.
Following our last inspection the registered provider sent us an action plan with details of the improvements they planned to make to meet the requirements of the regulations. At this inspection we found that sufficient improvements had not been made and the registered provider remained in breach of these three regulations. We also found three further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were; Regulation 12, Safe care and treatment; Regulation 13, Safeguarding service users from abuse and improper treatment; and Regulation 16, Receiving and acting on complaints.
The overall rating of the service is inadequate and the service is 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.
There was a manager at the service, but they were not registered with the CQC. The nominated individual (representative of the registered provider) told us the manager had applied to be registered. 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.
Staff recruitment procedures were not safe. Relevant checks had not always been completed to ensure staff were suitable to work in the care profession.
Medicines were not managed safely. People’s medicine administration records (MARs) were not always up to date. Staff competencies in medicines management were not regularly checked.
The registered provider did not have adequate systems in place to ensure people were protected from abuse.
Staff had not received regular supervisions or annual appraisals which meant their performance was not formally monitored and areas for improvement may not have been identified.
Some staff training was overdue so staff had not been supported to maintain and update their skills and knowledge.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. There were no records of any care staff undertaking mental capacity training. However, staff spoken with were clear on the importance of involving people in making decisions. We recommend the registered provider considers providing training for staff on the Mental Capacity Act.
People’s privacy was not always respected. This was because the registered provider shared a reception area with another organisation.
Four people did not have a written care record in place. This would have included risk assessments, which would have given staff information on how to reduce any risks to the person. Where people had care plans and risk assessments in place these had not been reviewed since the registered manager left the service in July 2018.
The registered provider had a compliments, comments and complaints policy and procedure in place. However, the registered provider did not have an effective system in place for identifying, receiving, handling and responding appropriately to complaints and comments made by people or persons acting on their behalf.
The registered provider had not ensured there were effective systems in place to monitor and improve the quality of the service provided.
The service had policies and procedures in place. However, they had not been reviewed and therefore may not have represented the most up to date legislation and good practice guidance.
People and their relatives told us the staff were kind and caring.
Staff told us the manager and nominated individual were approachable and supportive.
During this inspection we found a total of six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.