Background to this inspection
Updated
10 December 2019
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 was carried out by an inspector and an Expert by Experience. An Expert by Experience (EXE) is a person who has personal experience of using or caring for someone who uses this type of care service. They made telephone calls to discuss people’s experiences of the care and support received.
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 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection site visit activity started on 10 September 2019 and ended on 13 September 2019. We visited the office location on all four days to see the registered manager and office staff; to review care records and policies and procedures. The EXE made telephone calls to people on 11 September 2019.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. 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.
During the inspection-
Throughout the inspection we gave the provider and registered manager opportunities to tell us what improvements they had made since our last visit.
We conducted two home visits and spoke with two people and their relatives about their experience of the care provided. We spoke with eight people on the telephone, three care staff, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We viewed seven care plans, three staff files in relation to recruitment, induction and supervision, training data, policies and procedures and a variety of records relating to the management of the service.
We requested additional evidence to be sent to us after our inspection. This was received, and the information was used as part of our inspection.
Updated
10 December 2019
About the service:
Privilege Care Limited has one registered location. The office is situated within walking distance of Slough’s High Street, railway station and transport links. At the time of our inspection, 17 people were supported with personal care.
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:
During this inspection, we checked to see if the provider had addressed the concerns found at our previous visit on 28 January 2019. We found the provider did not make the improvements it told us it would, and there were multiple repeated breaches of the regulations. There were systemic failures in the provider’s quality and assurance systems, and records relating to care and the management of the service were either incomplete, inaccurate and/or not kept up to date. This compromised the quality and safety of the service provided.
Systems in place to protect people from abuse were ineffective. Although staff had attended relevant training, some staff were unable to demonstrate how they would safeguard people if alleged abused was disclosed. People could not be assured staff would recognise or respond appropriately to abuse. We have made a recommendation about the review of safeguarding systems. Risks to people’s welfare and safety were not managed appropriately.
The provider did not have enough qualified, competent, skilled staff and recruitment and selection procedures, did not ensure people were only supported by staff who were suitable to do so.
Although some improvements had been made in relation to the safe management of medicines, further improvements were needed to ensure medicines were managed safely at all times. This placed people at risk of potential harm. We have made a recommendation about medicines management and medicines management policies and procedures.
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; as the policies and systems in the service did not support this practice.
The provider failed to ensure staff had the appropriate knowledge and skills to meet people's needs effectively. The delivery of care and support was not personalised to meet people’s specific needs. People’s rights under protected characteristics, were not always protected as staff did not understand their responsibilities.
The registered manager failed to document meetings with people and their relatives therefore, we were unable to determine whether the care delivered still met their care and support needs. The provider did not meet the requirements of the Accessible Information Standard as, there had not been an assessment of people's communication needs to ensure these were met. Systems in place to handle, record and deal with complaints were not effective.
People and relatives felt staff were caring and respectful. People said staff supported them to live healthier lives, access healthcare services and to eat well balanced meals. People were protected from the risk of infection. The provider sought the views of people and relatives about their experiences of using the service. However, at the time of our visit the provider had not taken any action to analyse and respond to the feedback received.
Rating at last inspection and update: The last rating for this service was inadequate (published 20 July 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. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected:
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the full report.
Enforcement
We have identified breaches in relation to person-centred care, obtaining consent from people to receive care and support, receiving and acting on complaints, ensuring staff are well supported and trained to provide effective care, recruiting staff that are suitable for the role and good governance.
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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
The overall rating for this service is 'Inadequate' and the service is therefore 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 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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk