Archived: CRG Homecare - Hammersmith

Updated 14 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned in response to the Care Quality Commission receiving information of concern, which indicated that people who use the service may have been placed at risk through not being provided with safely delivered care and support.

This inspection was announced. We advised the registered manager two days before the inspection date that we would be coming, because the registered manager and other senior staff are sometimes away from the office visiting people who use the service and supporting staff. Therefore, we needed to make sure that members of the management team would be in. One adult social care inspector and one inspection manager carried out the inspection. The team inspected the service againt four of the five questions we ask about services: is the service safe, effective, responsive and well-led.

Prior to the inspection visit we looked at information we held about the service. We reviewed any notifications sent to us by the manager about significant incidents and events that had occurred at the service, which the provider is required by law to send us.

During our inspection we spoke with a care co-ordinator, a field care supervisor, the manager and the operations manager. We looked at a range of records that included 12 people’s care records and the recruitment, training and development files for four care staff. We also checked policies and procedures, and documents relating to the monitoring of the quality of the service including the management of complaints and different audits conducted by the provider. Following the inspection visit, we spoke by telephone with 11 people who used the service, the relatives of another three people and five care staff. We contacted health and social care professionals to find out their views of the service and received two responses.

Updated 14 December 2016

This focussed inspection was conducted on 11 October 2016 and was announced. We gave 48 hours’ notice of the inspection to make sure the staff we needed to speak with were available.

The service has not yet undergone a comprehensive rating inspection. We conducted the inspection as a result of obtaining information of concern, which indicated that people who use the service may have been put at risk by not receiving safely delivered care and support. This report only covers our findings in relation to the areas of concern raised and we therefore have not been able to provide a rating for some key questions.

CRG Homecare - Hammersmith is a domiciliary care agency that provides personal care to people living in their own homes. We were informed by the provider that there were approximately 270 people using the service. The service was registered by the Care Quality Commission (CQC) on 2 June 2016.

At the time of this inspection there was no registered manager in post. A registered manager is a person who has registered with 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. The service was being managed by a relatively newly appointed manager who planned to apply to the Care Quality Commission for registered manager status.

The provider had purchased another domiciliary care organisation, Geneva Health International Limited - London. During this inspection we made enquiries as to whether Geneva Health International Limited - London was being operated separately or as part of CRG Homecare – Hammersmith. The operations manager explained that Geneva Health International Limited –London had been acquired and that two CRG Homecare staff members lead on this area of the business, which involved providing personal care to 12 people. The operations manager said that healthcare assistants were provided to people and stated there were no clinical aspects to the tasks they carried out. She confirmed that nursing care was not provided at this stage. The provider was advised to check whether the service met the criteria to register to provide the regulated activity of Treatment of Disease, Disorder and Injury (TDDI). The provider also informed us that the service was relocating to a temporary address two weeks after the inspection.

During this inspection we found that the provider did not demonstrate that staff recruitment was consistently carried out in a thorough manner that protected the people who use the service.

People were positive about the caring and helpful approach of their regular care workers. Staff were described as being punctual and reliable. However, a significant number of people informed us that they did not receive their personal care from regular staff that they knew and felt comfortable with during the weekends, which they found unsettling.

People felt safe with their regular care workers, who understood how to protect people from the risk of abuse. Staff were provided with guidance about the risks that people were susceptible to due to their health care needs and any risks associated with their home environment.

Staff received appropriate training and support to effectively meet people’s needs. This included training and guidance in regards to the importance of seeking people’s consent before providing personal care and supporting people to make their own choices and decisions. People reported that they felt consulted about how they wished their care and support to be delivered. However, the care and support plans contained inconsistent information about people’s capacity to make decisions which the provider was addressing.

People received appropriate support to meet their nutritional and health care needs, and staff received suitable training and monitoring to ensure people were safely prompted to take their prescribed medicines.

Assessments were carried out to identify people’s needs and plan their care and support. These assessments were detailed and actively sought people’s own ideas and wishes about how their care should be delivered. The assessments were used to develop individual care and support plans.

Although people understood how to make a complaint and complaints were properly investigated, the complaints guidance for people and their relatives needed to be updated to demonstrate that the provider worked in a flexible and responsive manner in relation to the management of complaints.

Staff spoke positively about how they were managed and supported. Systems were in place to monitor the quality of the service, including unannounced ‘spot checks’ to people’s homes and telephone monitoring calls; however, the provider did not demonstrate an effective system for ensuring that these type of checks were periodically undertaken. The provider showed that important information, for example accidents and incidents, was methodically gathered and reported to the local authority homecare contracts team. It was not evident though how this information was used to inform the provider’s own drive to improve the quality of its service.

We found one breach of Regulations in relation to the provider not ensuring that recruitment was robustly undertaken. You can see what action we told the provider to take at the back of the full version of this report.