Background to this inspection
Updated
12 January 2024
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 Health and Social Care Act 2008.
Inspection team
The inspection team consisted of 2 inspectors and 2 Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post, who was also the owner and Nominated Individual (NI) of the service. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
Notice of inspection
The inspection was unannounced.
Inspection activity started on 27 November 2023 and ended on 8 December 2023]. We visited the location’s office on 27 November and 4 December 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authorities where Engage Care Services provided support. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 14 members of staff including the NI / registered manager, care coordinators, recruitment manager and support workers. The Experts by Experience spoke with 2 people who used the service and 12 relatives. We emailed all the staff team to gather their feedback on working for Engage Care Services.
We reviewed a range of records, including 8 people’s care plans and multiple medication records. We looked at 7 staff files in relation to recruitment. Following our visits to the service’s office we requested further information to be sent to us. A variety of records relating to the management of the service, including quality assurance, complaints and safeguarding were reviewed.
Updated
12 January 2024
About the service
Engage Care Services – Main Office (known as Engage Care Services) is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 71 people at the time of the inspection, including older people, those living with dementia and people with a physical disability.
People’s experience of the service and what we found:
Not all risks had been assessed. Guidance for support workers to manage risks and provide the required support was not always in place or was often brief and generic. Guidance from other professionals involved in people’s care and support was not included in the care plans for staff to follow.
Medicines were not well managed. Information about critical medicines and signs of a possible deterioration in health conditions was not recorded in people’s care plans. Where the provider was responsible for reordering people’s medicines there was no system in place to do this resulting in medicines being unavailable. Staff had access to PPE, but we were told they did not always use this correctly.
The provider’s recruitment policy was not fully followed to ensure all relevant information and checks were in place. During our inspection we were notified by the UK Visa and Immigration (UKVI) service that the provider’s licence to employ overseas workers had been suspended. UKVI are continuing their investigations and CQC are working with the relevant local authorities to ensure potential concerns for people using the service’s welfare due to UKVI’s decision.
Staff completed a range of training courses, however, there continued to be performance issues raised by people using the service, relatives, and local authorities around staff competencies. There were ongoing concerns around supporting people with personal care, maintaining people’s dignity and providing appropriate meals for people. Issues identified were not followed up with the relevant staff to improve their performance.
There were communication barriers with a large proportion of the staff team, people struggled to understand some of the support workers and they in turn weren’t able to always understand the people they were supporting or their relatives.
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; the policies and systems in the service did not support this practice. The service relied on the local authority assessing people’s capacity when support was initially agreed. They did not review people’s capacity once they started receiving support. We have made a recommendation for the service to follow best practice guidance in regard to the MCA.
The provider did not have a quality assurance system in place. There were no regular audits completed and no analysis of incidents or concerns raised to reduce the risk of a reoccurrence.
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 16 September 2022) and there was 1 breach of regulations. 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 the provider remained in breach of regulations. This service has been rated requires improvement for the last two inspections.
At our last inspection we recommended the service updated their satisfaction surveys and quality assurance systems. At this inspection we found the quality assurance systems were not robust.
Why we inspected
The inspection was prompted in part due to concerns received about poor personal care, communication issues with the support workers and medicines management. A decision was made for us to inspect and examine those risks.
When we last inspected Engage Care Services breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.
Enforcement and Recommendations
We have identified breaches in relation to medicines management, managing risks people may face, maintaining people’s dignity when providing care and the management of the service and staff team.
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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
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.