About the service ICare Solutions Manchester Limited is a domiciliary care agency. The service provides care and support to older adults living in their own homes in the Trafford, Manchester, Wakefield and Congleton areas.
ICare Solutions Manchester Limited also provides care and support for people referred to the Stabilise and Make Safe (SAMS) service, contracted by Trafford local authority. This service focuses on helping people regain their confidence, strength and independence following an illness, accident or hospital stay.
At the time of this inspection the service was providing care and support to 114 people. 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
The registered manager or provider were not able to demonstrate improvements made to the service since the previous inspection. Systems to monitor the quality and safety of the service were either not in place or were ineffective. The provider had not identified the issues we highlighted during the inspection, such as those relating to management and oversight of the service, safe recruitment, timely care planning and use of the electronic call monitoring systems.
There was insufficient provider oversight of the service, including the two satellite hubs in Wakefield and Congleton. The registered manager of the Manchester branch was unable to devote the time needed to the Manchester service as they also assumed a regional role within the wider iCare company. Records we requested in relation to the two satellite hubs of Congleton and Wakefield were not available at the Manchester office. Where action had been taken to try and improve quality and safety of care this did not always accurately reflect the provider’s policies or processes.
The provider monitored staff timeliness through electronic call monitoring. Usage of this by staff was inconsistent across all areas of the business. Where this was used, electronic call monitoring records indicated that some calls were cut short. Where people did not regularly receive their commissioned support in full, we saw no evidence that commissioners were contacted to carry out reviews of care.
Recruitment was not undertaken in a safe way. Staff received pre-employment checks prior to commencing employment, however, these were not always appropriately actioned or followed up. Actions identified to mitigate identified risks were not followed. There was not always a clear rationale documented for why the company judged a potential employee was suitable to work with vulnerable adults when potential risks had been identified.
People were receiving their medicines as prescribed. People felt the staff providing support were competent. The provider had taken action to keep people and staff safe during the COVID-19 pandemic. The provider had shared government guidelines and other information about COVID-19 and staff had access to full personal protective equipment.
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 requires improvement (published 23 January 2020) and there were three breaches of regulation. At this inspection we found improvements had not been made and the provider was still in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 6, 8 and 12 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the breaches in person centred care, good governance and the requirement to display the rating.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for iCare Solutions Manchester Limited on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to good governance, person centred care and recruitment of staff at this inspection. The provider could not demonstrate improvements since the last inspection in good governance and person centred care. For these repeat breaches in regulation we issued two warning notices which were accepted by the provider.
Follow up
We will request an action plan for 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.
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.