Archived: CRG Homecare - Leicestershire

CRG Homecare - Leicester is a domiciliary care agency. It provides personal care and support to older and younger people living in their own homes. At the time of inspection 170 people were receiving personal care from the service.

People’s experience of using this service:

People told us they were not always happy with care they received. People felt that whilst some regular staff were of good quality, they often had visits from staff they did not know, and agency staff who did not know how to care for them.

People told us they were not regularly informed about which staff would be visiting them.

People told us that call timings were a problem. Many people said that staff were either significantly early or late, and they could not rely upon their care being delivered at a specified time, thus providing an inconvenience to them.

People were treated with kindness and respect by the staff that were known to them, however some people felt uncomfortable with staff they did not know.

Staff training took place, but there were gaps including a significant amount of staff whose moving and handling training had expired.

People mostly received the support they required with food and drink, although staff did not always accurately record people’s food and fluid intake when required.

Staff visits were not always effectively monitored.

The assessment of risk had improved. Risk assessments were in place to manage risks within people’s lives, and people we spoke with were happy with them.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

Improvements had been made to medicine administration systems, including the application of topical medicine.

Staff were supervised well and felt confident in their roles.

Healthcare needs were met, and people had access to health professionals as required.

People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

People were supported in the least restrictive way possible.

Care plans contained person centred information and reflected people likes, dislikes and preferences.

People and their family were involved in their own care planning as much as was possible.

A complaints system was in place and was used effectively.

The management team were open and honest, and had been working in partnership with outside agencies to improve people’s support.

Audits of the service were detailed and any issues found were usually addressed promptly.

Rating at last inspection and update: The last rating for this service was requires improvement (published 10 October 2018) and there was a breach 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 we found improvements had been made in several areas and the provider was no longer in breach of this regulation. However, we found that other improvements were still required throughout the service, and new breaches of regulation had occurred. The rating remains requires improvement.

This service has been rated requires improvement for the last three consecutive inspections, and is therefore in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Good Governance.

Why we inspected

This was a planned inspection based on the previous rating.

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.

CRG Homecare – Leicestershire is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older and younger adults some of whom are living with dementia, physical disabilities, sensory impairments, and mental health issues. At the time of our inspection there were 201 people receiving care and support from the service.

At our last inspection of this service on 27 September 2017 we found three breaches of the regulations because the service was not always safe, responsive, and well-led. We issued a three requirement notices. At this inspection we found that two of these requirements had been met but the service was still not fully compliant with one of our regulations.

The service did not have a registered manager. 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. The last registered manager had de-registered on 08 February 2018. At the time of our inspection a new acting manager had been appointed and was in the process of applying to register with CQC.

We found a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations Safe care and treatment. Although improvements had been made to some care plans and risk assessments others were not in place where necessary, or did not contain the information care workers needed to provide safe care and support.

The timeliness of calls had improved since our last inspection and most people and relatives said their calls were now on time. People felt safe using the service. Medicines were better managed and administered safely. People were protected by the prevention and control of infection. The management of complaints had also improved and people and relatives told us they would speak out if they had any concerns about the quality of their care.

People and relatives told us the care workers treated people with kindness and compassion. They said they were flexible and went out of their way to support people in the way they wanted. People mostly had regular care workers so they could get to know them. The care workers we spoke with were caring and committed to providing good quality care. They understood the importance of supporting people to express their views about the type of care and support they wanted.

Care workers were mostly well-trained and experienced. They supported some people using the service to eat and drink enough to maintain a balanced diet. If people needed medical attention care workers alerted their families and healthcare professionals. Care workers sought people’s consent before providing any care or support and understood their responsibilities under the Mental Capacity Act 2005.

People received responsive care that met their needs. People and relatives made many positive comments about the quality of the care provided. Most of the care plans we saw were personalised and written from the perspective of the person using the service. The management team were in the process of reviewing and improving all care plans to ensure they were of good quality and based on best practice guidance.

Records showed that any complaints received were recorded along with the action taken to resolve them and the outcome. The provider had amended and updated the service’s complaints procedure. People and relatives were confident that if they raised a concern they would be listened to and action taken to resolve any issues they might have.

The provider had developed a quality assurance system and carried out a series of audits to identify any shortfalls in the service. They were working to an improvement plan to address these. People, relatives and care workers told us the service had improved and they had confidence in the new management team who they said listened to them and took action when it was needed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

A registered manager was in place. 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 and associated Regulations about how the service is run.

Risk assessments were not consistently in place to protect people from risks to their health and welfare. Staff recruitment checks were in place to protect people from receiving personal care from unsuitable staff.

Calls to provide care to people were not always at the agreed and assessed times, which meant people’s safety had not been comprehensively promoted to ensure they received care at the times they needed.

People and relatives we spoke with told us they thought the service ensured that people received safe personal care from staff. Staff had been trained in safeguarding (protecting people from abuse) and staff understood their responsibilities in this area.

We saw that medicines had been, in the main, supplied safely and on time, to protect people’s health needs.

Staff had received training to ensure they had skills and knowledge to meet people's needs. However, more specialist training on people’s health conditions had not yet been provided to allow staff to understand the challenges people had in their lives.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives. Assessments of people's capacity to make decisions were in place to determine whether they needed extra protections in place.

People and relatives we spoke with all told us that staff were friendly, kind, positive and caring. People told us, in the main, they had been involved in making decisions about how and what personal care was needed to meet their needs.

Care plans were individual to the people using the service to ensure that their needs were met, though this did not include all relevant information such as full details of people's preferences, likes and dislikes.

People and relatives told us they would tell staff or management if they had any concerns, but they were not all confident issues would be properly followed up. A number of people and relatives were not satisfied with how the service was run, with concerns about untimely calls and unresponsive senior management staff. Staff did not feel they were supported in their work by the senior management of the service.

Notifications of concern had been reported to us, as legally required, to enable us to consider whether we needed to carry out an early inspection of the service.

Management had not audited the service comprehensively in order to check whether people's needs had been fully met and to take action as needed to ensure people were provided with a quality service.