About the service: Yes Care Limited is a domiciliary care agency providing personal care and support to people living in their own homes in the community. The provider is a privately run organisation and this is the only registered location. The agency also provides other care and support which does not include personal care. CQC is not responsible for regulating these aspects of the service. At the time of the inspection 10 people were receiving support from the agency. The registered manager told us that seven people were receiving personal care (which includes support with medicines) and three people were receiving other support. However, feedback from one member of staff which we received after the inspection visit, included information which indicated one other person was receiving support with personal care.People’s experience of using this service:
People using the service were not safe. The risks to their safety and wellbeing had not always been assessed or planned for. The staff were undertaking tasks which they had not been trained to do and the provider had not assessed their competencies or skills. These included using medical devices and supporting people with multiple and complex healthcare needs.
The provider did not ensure the safe and proper management of medicines. Information about medicines was not always completed in people's care plans or risk assessments. The provider had not trained staff to safely manage medicines and they had not assessed their competency or knowledge regarding this. The provider had not seen or audited medicines administration records, so they could not be confident that people had received their medicines as prescribed.
People were placed at risk of abuse and harm. The provider did not ensure safeguarding procedures were followed. They provided care to children under the age of 18 years. This care had not been planned for or risk assessed. The staff had not been trained to safely care for children and when there had been incidents involving these children the provider had failed to take the appropriate action to notify the local safeguarding authority.
The provider did not have systems for learning from accidents, incidents and concerns. Throughout our inspection we identified records where staff had recorded accidents and concerns. There was no evidence these had been investigated. The relative of one person told us that when they raised concerns these had not been responded to appropriately. There was no record of these concerns or action taken by the provider.
The provider did not ensure staff were suitable to work at the service. They did not follow their own recruitment procedures because they had not carried out all the necessary checks on staff. They did not provide a comprehensive induction for staff or assess their skills and competency in any areas. There was no evidence of 'spot checks' to observe the staff in the work place or supervision meetings where the staff would discuss their work with their line managers.
The provider had not undertaken any assessments of people's capacity or obtained written consent for the care they were providing.
The staff were not always kind, caring or respectful. Some of the records staff had completed showed disrespect and contempt for the vulnerable people they were employed to care for.
Some people's needs had not been assessed or planned for. Care plans did not include how to support people with all aspects of their care. Some care plans included information which related to completely different people. In some cases, this placed people at significant risk because the documents indicated people should be offered drinks when they were unable to swallow and had been assessed as 'nil by mouth.'
The systems for monitoring the quality of the service were not being implemented effectively. The provider had failed to recognise the wide spread deficits in the service. Where concerns had been identified by the provider's own quality monitoring they had not taken action to put things right.
Following our initial feedback after the inspection visit, the registered manager explained that they had taken some action to address the concerns which we had highlighted. We wrote to them asking them for further assurances. They sent us an initial action plan and offered to provide evidence of some of the actions they had taken.
Before our inspection visit, the provider had experienced a loss of computerised records. The registered manager informed us that some of the documents which were absent at the time of the inspection were in place but could not be accessed. They told us they were communicating with the on line cloud provider in order to try and retrieve this data.
Some people who used the service were happy with the staff who supported them. In particular, one relative explained how the care staff had helped them to communicate with other healthcare professionals. Some of the staff were also happy and felt supported. They said they could ring the office staff and ask for support, and that this was given when they needed it.
We identified breaches of nine Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to person centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing, fit and proper persons employed. We also identified one breach of the Health and Social Care Act 2008 (Registration) Regulations 2009 relating to notifications.
Rating at last inspection: This was the first inspection of the service since it was registered in May 2017. There was no one receiving a service until September 2018, which is why we had not inspected before this.
Why we inspected: The inspection was carried out as part of our scheduled plan of inspections.
Enforcement:
We have taken action against the provider for failing to meet Regulations.
We have cancelled the registration of the manager and imposed conditions on the registration of the provider.
Full information about CQC's regulatory responses can be seen in our table of action.
The service has been rated 'inadequate' and 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.
Follow up:
We will continue to monitor the service and will undertake another comprehensive inspection within six months or sooner if needed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk