About the service:

Circle of Care Service, West Green Learning Centre, Park View Academy 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 the whole population.

At the time of the inspection it was providing a service to 19 people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

People told us that care workers were kind and caring and they felt safe using the service.

However, we found significant shortfalls in the way the service was managed, which meant that people might not always receive safe, effective, responsive or well led care.

The management of risk was not effective, and placed people at risk.

Medicines were not safely managed. Medicine audits had not identified errors.

Safe recruitment processes were not always followed to ensure staff were suitable to work with vulnerable people.

Records relating to staff induction, supervision and training were incomplete.

There was no effective system to determine if people received their care as required or as planned.

Care plans did not always contain information about people’s preferences or choices. Where there was information, care was not always delivered in line with it.

Staff told us that they understood the Mental Capacity Act and that they gave people choices, however we found confusing information in one person’s care plan about their level of capacity and how decisions were made either by them or on their behalf.

The registered manager did not fully understand their responsibilities. The service was not well led and there was a lack of robust and effective processes in place to monitor the quality and safety of the service.

Rating at last inspection:

At the last inspection this service was rated ‘Requires improvement’ (report published on 13 April 2018). We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, recruitment and good governance. At this inspection we found that the registered provider had not complied with these breaches. This is the third time the service has been rated requires improvement or below.

Why we inspected:

This was a planned inspection based on the previous rating.

Action we told provider to take:

Full information about CQCs regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Enforcement:

We have found five breaches of the regulations and the service is now rated Inadequate in two key questions and overall.

We have made four recommendations about incident recording, seeking healthcare professional advice, recording of mental capacity assessments and complaints.

Follow up:

We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The overall rating for the service is inadequate, the service will be placed in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months to check on improvements.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the longest 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 inadequa

This inspection took place on 3 and 6 November 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service for adults; we needed to be sure that someone would be in. Circle of Care Services Limited is registered to provide nursing and personal care. At the time of this inspection it was providing personal care to people living in their own home. At the time of our inspection there were 49 people receiving care.

The service was last inspected in July 2016 and was rated as requires improvement and we found three breaches of the Regulations. The provider was not implementing safe recruitment practices to ensure staff we suitable for working with people. Secondly the provider was not providing regular supervision sessions or annual appraisals to all staff, and thirdly the provider did not have effective systems and process in place to assess, monitor and improve the quality and safety of service provided. At this inspection we found the provider had made the necessary improvements around staff supervision but issues remained with their recruitment practices and their governance of the service.

There was a registered manager at the service at the time of our inspection. 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 provider did not have robust recruitment practices in place to ensure staff were suitable for working in the caring profession. The provider had not always obtained an employment history, proof of identity and verified references for staff.

People were not always protected from risks to their health and wellbeing because risk assessments to guide staff did not provide sufficient detail for staff about how to manage specific risks.

Medicines were not always well managed. Medicine administration records did not contain the dosage of the medicines prescribed nor when they were to be taken so the service could not be assured that people were receiving their medicines as prescribed. The service did not provide guidance to staff about how to support people who required medicines on an ‘as required basis’.

The provider was not set up in a way that promoted safe care through effective quality monitoring because the service’s audits had not highlighted and addressed the concerns we found during the inspection.

People and staff told us there were sufficient staff to ensure people’s needs were met and they felt safe and were protected from the risk of potential abuse.

Staff received the training and supervision they needed to perform their roles.

People’s consent to care was recorded in their care plans and people with delegated authority had signed to consent to care on people’s behalf where appropriate.

People told us they were supported to get enough to eat and drink and people had access to healthcare professionals. People told us staff wore gloves to prevent the spread of infection.

People told us staff developed caring relationships with people using the service and respected people's diversity and privacy. People and their relatives were involved in planning their care and care records included information about people's likes and dislikes and promoting their independence.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding recruitment, safe care and treatment and governance. You can see what action we told the provider to take at the back of the full version of this report.

This is the second consecutive time the service has been rated requires improvement.

The inspection took place on 19 and 20 July 2016. This was an announced inspection. We gave the provider 48 hours notice of the inspection as this is a domiciliary care agency and we wanted to ensure the registered manager was available in the office to meet us. We last inspected the provider on 6 February 2014.. At this inspection, we found the provider to be compliant.

Circle of Care Service is a domiciliary care service run by Circle of Care Service Limited. The service provides personal care to over 90 people with dementia, mental health needs or a physical disability. The service supports both older people and younger adults in their own homes. On the day of inspection 92 people were receiving services.

The service had a registered manager who has been registered with the Care Quality Commission at this location since 4 July 2012. 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.

People using the service and their relatives told us they found staff caring, friendly and helpful. They told us that their health and care needs were met. People told us that staff respected their privacy and dignity. Staff were able to demonstrate their understanding of the needs and preferences of the people they cared for by giving examples of how they supported people.

Care plans were detailed and recorded individual needs, likes and dislikes. Risk assessments were individualised but lacked detailed information on safe management of the risks. Care plans and risk assessments were regularly updated and reviewed. There were gaps in the care delivery records. The service maintained clear records of medicines that were prompted by staff in people’s care delivery records.

There were safeguarding policies and procedures in place. Staff were able to demonstrate their role in raising concerns. Staff had a good understanding of the safeguarding procedure and the role of external agencies.

Staff files had records of application forms, interview notes and reference checks. However, some staff files did not have recent criminal record checks.

Staff told us they were supported well and we saw records of staff supervision. Staff told us they attended induction training and additional training, and records confirmed this.

The service had systems and processes in place to assess, monitor and improve the quality and safety of service provided. There was evidence of regular monitoring checks of the service.

We have made a recommendation about a review of risk assessments and staff training on medicines management.

We found that the registered provider was not meeting legal requirements and there were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staff recruitment, record-keeping and staff supervision and appraisal.

You can see what action we told the provider to take at the back of the full version of the report.

People told us they were involved in decisions in relation to their care and support needs. They also told us that they were happy with the care and support they received and that they were able to make choices in regards to this care. One person said “Care is excellent.”

We reviewed care plans and found they contained information about people’s care and details of when other health professionals had been involved in the care given.

Staff had access to training such as the safeguarding of vulnerable adults and had an awareness of the signs and symptoms of abuse and how to report abuse.

We reviewed employee files and saw evidence that staff had received training and were being supervised.

There was a system in place for monitoring service provision.

At the time of the inspection forty-six people were using the service, and we had the opportunity to visit or speak with twelve of them or their relatives. Since the previous inspection the agency had relocated to larger premises.

People were generally very positive about the service, indicating that they were provided with the care that they need, and were given choices about the support they received. In discussing the service people told us “I’m more than happy,” “I’m very satisfied,” “They work well,” “They are on time,” and “They call up to check if everything is OK.”

People had formed good and supportive relationships with staff and management, and felt able to speak up about any concerns that they might have. One person advised “They can be a bit inconsistent, but they are better now.”

Appropriate staff recruitment procedures were in place and staff received effective support and supervision from management. A training plan was in place to ensure that all staff worked in line with best practice, and quality assurance procedures had been developed to ensure that people received a high standard of care and support.