About the service:

Crystal Caring is a domiciliary care agency that was providing personal care to 13 people at the time of the inspection.

People's experience of using this service:

We identified six breaches of regulations. These were in relation to safe care and treatment, safeguarding procedures, mental capacity, good governance and the registered managers responsibilities.

At the last inspection on 28 March 2018, we found risk was not managed appropriately. At this inspection we found these concerns continued. People had assessments and plans regarding their care and support needs. However, the care plans lacked important information, were not always kept up to date when changes occurred and had limited guidance for staff in how to deliver individualised care.

Medicines management was not based on current best practice and medicines were not managed safely and in line with national guidance. The systems in place to safeguard people and monitor incidents were ineffective.

People were not always supported to have maximum choice and control in how they wanted their support to be delivered.

The overall governance of the service was not robust and had failed to ensure that people received a service that was safe and in line with best practice. It had failed to ensure that issues were not only dealt with but that subsequent improvements were sustained.

Staff received adequate training People were confident in the ability of staff to provide the support that they needed.

People gave positive feedback about the support they received. There was a small team of dedicated staff committed to providing a caring service to people.

More information is in the detailed findings below.

Rating at last inspection:

Requires improvement, report published 1 May 2018

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website.

Follow up:

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

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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.

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. We will have contact with the provider following this report being published to discuss how they will make cha

The inspection took place on 28 March 2018 and was announced. The provider was given 48 hours’ notice because the location provides domiciliary care services. The registered manager is often out of the office supporting staff or providing care. We wanted to make sure the registered manager would be available to support our inspection, or someone who could act on their behalf.

Crystal caring 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 adults. At the time of our inspection 18 people were currently receiving the regulated activity of personal care.

A registered manager was employed by the service and was present during 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.

During our previous inspection in May 2017 we found the provider did not meet some of the legal requirements in respect the risk to people’s health and welfare, medicines management, recruitment and the lack of obtaining consent. After the previous inspection the provider wrote to us with an action plan of improvements that would be made to meet the legal requirements in relation to the law. We found on this inspection the provider had taken some of the actions required to make the necessary improvements.

There were systems in place to promote the safe management of medicines. However, information on when people should have ‘as required’ (PRN) creams or medicines was not available to staff. There were some gaps in the recording on some of the medicine administration records we viewed. These gaps had not been identified during quality audits.

Risk assessments still required more detail for staff on how best to support the person to minimise the risk of harm.

The provider had systems in place to monitor the quality of service. Whilst the systems had identified some areas requiring improvement it was not robust enough to identify the concerns we found during the inspection. Staff and people’s views on the service provided were sought and where necessary acted upon.

Care plans were generic and did not always detail people's individual preferences, likes and dislikes. There continued to be insufficient guidance for staff on how to support people in line with their specific care needs.

Safeguarding process were in place to support staff to understand how to keep people safe. People and relatives told us they received safe care and staff were able to demonstrate a good understanding of what constituted abuse and how to report any concerns raised.

Appropriate recruitment processes were in place to reduce the risk of unsuitable staff being employed by the service. Staff received appropriate training and support from management to ensure they had the right knowledge and skills to meet people’s needs.

The service was working within the principles of the Mental Capacity Act 2005. Consent forms were now in place and people had signed to say they consented to care and support.

People and relatives spoke positively about the care and support provided by care staff. People and their relatives told us they received their care at the correct time. There were enough staff deployed to fully meet people’s health and social care needs. The service, where possible, tried to ensure people received care and support from the same members of staff to provide consistency of care.

There were processes in place to make sure that complaints were dealt with effectively. Any concerns raised had been dealt with and responded to in a timely manner by the registered manager.

Staff and people using the service spoke positively about the management of the service. The service

We carried out an inspection of Crystal Caring on 12 and 15 May 2017. This was an announced inspection where we gave the provider 48 hours’ notice. This was because the location provides a domiciliary care service and we wanted to make sure a manager would be available to support our inspection, or someone who could act on their behalf. This was the first inspection since the location had been registered as a domiciliary care provider in April 2016.

Crystal Caring provides a range of services to people living in their own homes, including personal care, within Swindon and the surrounding areas. At the time of inspection there were 13 people using the service; all of whom were receiving care under the regulated activity of personal care.

A registered manager was in place but was not available at the time of the 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 director and nominated individual of the company were s available during the inspection in the absence of the registered manager.

People who used the service told us they felt safe. However, some staff had not completed training in safeguarding prior to supporting people and were not able to tell us the definition of safeguarding or all of the different types of abuse. Despite this, all staff we spoke with knew how to respond to any allegation of abuse for example, how and who they should report concerns to.

Documentation to confirm safe recruitment practices had been followed was not consistently available in staff files.

People said they were satisfied with the support they received with regards to their medicines however; medicines were not always managed safely. The Medicines Administration Records (MAR) did not always provide sufficient information to enable the safe administration of medicines and documentation of medicines administered was not consistently completed. This meant people were at risk of not receiving their medicine as prescribed and according to the labelling. The registered manager told us during the inspection they had recently identified some of the issues in the way medicines were being managed and they were in the process of addressing and rectifying this.

There were sufficient staff employed to provide consistent and safe care to people. People said they had regular staff who knew them well and there were suitable arrangements in place to cover any staff sickness.

Staff completed competency assessments as part of their induction followed by supervisions and training. However, some staff had not received training in some aspects of care such as safeguarding and the mental capacity act. The monitoring of when staff training and supervisions were due was also not robust which meant some staff had training that had either not been completed or was overdue. Despite this, staff were knowledgeable about people’s needs and said they received the necessary training to equip them with the skills they needed to provide the care people required.

Staff were able to explain they understood the importance of ensuring people agreed to the support they provided. However, consent forms had not been completed by people receiving care. The company director told us they had recently noted this when they reviewed people’s care plans and told us they had scheduled time to go through this with each person during the week following the inspection in order to rectify this.

Staff helped to ensure people who used the service had sufficient food and drink to meet their needs. Some people were assisted by staff to cook their own food and other people received meals that had been prepared by staff.

People had access to health care professionals to make sure the