Archived: Clece Care Services Ltd (Gateshead)

We undertook this focused inspection on 4 and 5 April 2016 to follow up on the action we had taken and check if the provider was now meeting legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clece Care Services Ltd (Gateshead) on our website at www.cqc.org.uk.

Clece Care Services Ltd Gateshead provides personal care and support to people in their own homes in the Gateshead area. At the time of our inspection services were provided to 152 people, mainly older people including people with dementia-related conditions.

In the period since the last inspection the registered manager had left the service and another manager was now in the process of applying for registration. 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.

We found that staffing resources had been increased and there was capacity to meet people’s contracted hours of service. However, the recruitment of new staff was not fully robust.

There were improved systems in place for co-ordinating and monitoring the service which helped to prevent missed visits and protect people from neglect. Processes for managing safeguarding concerns had also improved but the provider had not ensured the Care Quality Commission was notified of such incidents.

Personal records had been updated, giving staff guidance on managing risks during care delivery and care plans to follow for meeting people’s needs. The arrangements for supporting people with their prescribed medicines were subject to closer scrutiny.

Action had been taken to improve the training, supervision and support provided to staff. A new manager was in post and the service was now being managed more effectively. The management had introduced quality assurance methods to check the standards of the service and the care that people received.

We concluded the provider had made progress in addressing the breaches of legal requirements, which will need to be embedded and sustained. We have not changed the ratings following this inspection as any improvements made have to be sustained over time in order for the ratings to be changed. The service is in ‘special measures’ and we will continue to monitor the safety and quality of the service being provided.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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 take action 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Clece Care Services Ltd Gateshead provides personal care and support to people in their own homes in the Gateshead area. At the time of our inspection services were provided to approximately 180 people, mainly older people including people with dementia related conditions.

The service had a registered manager in post. 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.

We found the service did not have enough staff and there was insufficient capacity to consistently deliver people’s care. Many staff had left employment and there were pressures on care workers to work extra hours. Management of the staff rosters was not effective and there was no proper system in place for checking visits and whether care workers had carried out their rostered calls.

There had been a significant number of times when visits to people were missed and their care was not given. Many of the staff were not trained in protecting people from abuse and robust procedures were not followed in response to safeguarding concerns.

Risks to people’s safety and welfare had not been clearly identified and acted on. Care records gave staff limited or no guidance about the ways to meet people’s needs and minimise risks. Appropriate arrangements had not been made to ensure that people received their medicines safely.

New staff were checked and vetted to ensure they were suitable to be employed. However, there was no documented evidence that new care workers had received training to prepare them for their roles. There was inadequate staff training provided and no structured systems for supervising staff and checking on their performance.

Staff reported concerns about people’s health and welfare to ensure they received input from health care professionals. Staff prepared meals and drinks for people who required such support to meet their nutrition and hydration needs.

No systems had been developed to enable people to give their formal consent to their care and treatment. The management lacked understanding of the implications of mental capacity law and the processes for upholding people’s rights.

The people and relatives we consulted had good relationships with their regular care workers. They told us staff were caring and most treated people with respect, though we found there had been some issues with lack of confidentiality.

With the exception of initial assessments of needs, the views of people and their families about their care had not been sought. None of the people using the service had care plans to demonstrate how their care must be provided and people’s care had not been reviewed.

Where people needed support aimed at preventing social isolation and to access the community this was provided. The service had a complaints procedure and action was taken to respond to complaints.

Poor governance arrangements were in place. Staff felt unsupported and morale was low. No systems had been implemented to assess and monitor the standards of the service and the quality of the care that people received.

Enforcement action is being taken as a result of our inspection findings outside of this report.