Background to this inspection
Updated
19 March 2020
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 three inspectors and an inspection manager. On 30 December 2019 two inspectors began to make telephone calls to people who used the service, their relatives and staff. On 8 January 2020 two inspectors carried out a visit to the agency’s office. On 15 January 2020 an inspection manager accompanied an inspector to the office to meet representatives of the provider. The inspection was completed on 30 January 2020.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 24 hours’ notice of the inspection visit to the site office on 8 January 2020. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. This included the provider’s action plan and the weekly reports the provider had sent us. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke over the telephone with seven people who received a service and another four people’s relatives. We spoke over the telephone with six staff and spoke with another six staff during our visits to the office. These staff included care workers, field-care supervisors, care coordinators, the registered manager, the Head of Business Development and Operations (referred to in the report as the provider’s representative) and the Operations Manager.
We looked at a range of records. These included five people’s care records, including medication records and daily care notes. We looked at two electronic staff files in relation to recruitment and folders relating to complaints and accident and incidents.
In between the two days we visited the office, the provider’s representative updated us on actions they had taken to address some of the issues we had found. Following our discussion with them during our second site visit, the provider’s representative updated us on further action they had taken.
Updated
19 March 2020
About the service
Atlas Care Services Ltd Wisbech is a domiciliary care agency providing personal care to people in their own homes. At the time of the inspection 113 people were receiving a service. 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
There was a continued lack of provider oversight of the service, in spite of the enforcement action we took following our last inspection. People’s health, safety and welfare continued to be at risk because the provider did not have effective systems in place to assess, monitor and improve the quality of the service. Ten of the 11 people/relatives we contacted told us they were not satisfied with the service they received. Staff continued to not be deployed effectively, which meant that care calls were frequently late, did not always last the correct amount of time and some people received care from a high number of different staff.
The provider had failed to manage safety effectively, which placed people at risk of harm. Risk management was not robust enough to ensure staff knew how to minimise risks to people. Safeguarding policies and procedures were not always followed, putting people at risk of abuse. Staff did not always have the training or support to carry out their role in line with current good practice.
People’s care plans had not all been reviewed or kept up to date so there was a risk that people did not get the care they needed in the way they preferred. Complaints were not always responded to and not addressed.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
We have made a recommendation about involving people in decisions about their care.
Some improvement had been made since our last inspection in that there had been far fewer missed calls. People spoke highly of the staff who provided their care and were satisfied with the way staff gave them food and drink.
During our first site visit there was a registered manager in post. They resigned from their post before the inspection was concluded.
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 inadequate (report published 10 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
This service has been in Special Measures since our last inspection. During this inspection the provider demonstrated that not enough improvements had been made and they remained in breach of regulations. The service is rated as inadequate overall and in three of the key questions. Therefore, this service remains in Special Measures.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
The provider had appointed senior staff to oversee and improve the service. However, they had been in post for three months but had not addressed and rectified the shortfalls we found at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Atlas Care Service Ltd Wisbech on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to complying with regulations; governance; staffing; safe care and treatment; person-centred care; complaints; and safeguarding people from abuse and avoidable harm at this inspection.
Please see the action we have told the provider to take at the end of this report. 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.
Follow up
We will request an action plan from the provider, to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.
Further update
Following the inspection we met with the provider to discuss the actions we would be taking. The provider told us they had decided to apply to CQC to remove the location from their registration. The regulated activity previously carried out from that location would be carried out from another of their locations. After the meeting the provider submitted their application to remove the location Atlas Care Services Ltd Wisbech from their registration from 01 march 2020.