This inspection commenced on 22 January 2018 and was unannounced. The inspection continued on 23, 24 and 25 January 2018. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our 30 August 2017 inspection had been made. Prior to this, Skillcare Limited had been inspected in April and November 2016 and April 2017 and was placed and remained in special measures. Skillcare Limited is a domiciliary care agency based in the London Borough of Barnet registered to provide personal care for people in their own homes who may need support around their physical or mental health and may have learning difficulties or dementia care needs. At the time of this inspection there were 36 people using the service. The majority of people's care was funded by the London Borough of Brent.
The service had a registered manager. In this report we will refer to this person as the ‘provider’. 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 previously inspected Skillcare Limited on 30 August 2017 and we identified repeated breaches of legal requirements in relation to safe care and treatment (Regulation 12) and good governance (Regulation 17).
At this inspection we found that although some improvements had been made to how the service assessed risks, the provider had failed to meet regulations in relation to safe care and treatment (Regulation 12) and good governance (Regulation 17). In addition, at this inspection, we identified breaches of regulation in relation to fit and proper persons employed (Regulation 19), staffing (Regulation 18) and a failure to display ratings (Regulation 20A). The service remains rated Inadequate and in special measures.
The provider did not ensure medicines were managed safely, Medicines Administration Records were not appropriately completed, contained gaps and were not updated to reflect people’s current prescribed medicines. The provider had not ensured staff were competent to handle and administer medicines.
We found that improvements had been made to how the service assessed risks to people associated with their care needs, however we found instances of identified risks not being assessed and risk assessments containing incorrect information.
There was insufficient staff effectively deployed to ensure people’s care needs were met. We found instances of people not receiving their visits as per their assessed care needs. The provider did not have systems in place to ensure care visits were monitored effectively. Some care visits were scheduled to run concurrently, overlapping or without sufficient travel time.
The provider did not ensure safe staff recruitment. Not all staff had undergone appropriate recruitment checks prior to working with vulnerable people or having access to people’s confidential information.
Care plans were for the most part person centred and detailed. However the provider had recently switched to a new electronic care planning system which meant that care plans had lost detail around people’s needs, likes and dislikes and life histories. We found instances of care plans containing incorrect and inaccurate information.
Most people told us that felt safe with staff from Skillcare. However some people told us of frequently changing staff meant that they felt less secure than they had done previously.
Records indicated that staff had received regular training and an induction. However, we found inconsistencies with how staff received supervision and an annual appraisal.
People had their care needs assessed prior to receiving service. However we found inconsistencies in the provider’s assessment process and important information obtained in the care assessment was not carried through to the persons care plan.
Most people told us staff were caring; however we were told if instances of staff not delivering care as per the person’s assessed care needs.
Complaints were documented and investigated as per the provider’s complaints policy.
New audits had been introduced to monitor the overall quality of the service, however they had failed to pick up issues identified at the inspection.
We received mixed feedback from people and relatives regarding the overall running of the service. Care staff spoke positively of the management team and the support they received.
The overall rating for this service is 'Inadequate' and the service remains in 'special measures'. We are taking action against the provider for failing to meet regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.