About the service Be Caring Manchester is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 219 people at the time of the inspection, including older people, those living with dementia, people with a physical disability and younger adults.
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
People were not safe. Staffing levels and rota systems were unsafe. People's calls were significantly late, early, short or missed. People and their relatives told us staff were often late or missed calls completely. One person commented, “They [care workers] are supposed to come to give me a shower at 10am, they are late every time, sometimes they arrive at 12 or 12:30pm.” Care workers rotas were unclear and inconsistent, which meant staff were not able to stay at people’s homes long enough to safely meet their needs. More than half of people’s planned care time had not been delivered.
People were not always safeguarded from the risk of abuse, particularly neglect, due to late, early, short and missed calls. People and their relatives were unable to rely on the service to provide essential care. One person commented, “I have three calls a day. Last week no-one came all day and the next day a carer came for one call.”
Medicines were not managed safely. There was a lack of oversight of medicine administration and medicine records were not always complete. We were not assured people always received their medicines as prescribed.
Risks to people's health and wellbeing had not always been assessed, monitored or mitigated effectively. People were at risk of harm because staff did not always have the information, they needed to support people safely.
People's care and support was not person centred and frequently provided at times not to their preference. Care teams were not consistent, so people were supported by multiple care staff they did not know. People's support plans did not always contain detailed or accurate information to help staff support people safely.
People's complaints were not dealt with appropriately, so people had lost confidence in sharing their concerns or feedback with the service. People did not feel involved in their care and support.
People were not always 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 provider had not established an effective system to ensure people were protected from the risk of abuse. Accidents and incidents were not appropriately reported, and actions were not always taken to ensure the safety of people.
The provider's systems to assess, monitor and improve the quality and safety of service being provided were inadequate. Senior staff and governance systems had not recognised or responded to the significant and widespread issues in a timely manner. A poor culture had developed at the service. Shortcomings in care, poor practice and a failure to meet people's needs were not always challenged but accepted. CQC had not been notified of all significant events which had occurred, in line with the registered provider's legal obligations.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
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.
Why we inspected
This was a five key question responsive inspection based on CQC receiving concerns and complaints. Prior to the inspection CQC received concerns about late and missed calls, lack of leadership and safeguarding concerns. The information shared with CQC indicated potential concerns about how people were being supported and risks being managed.
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 people receiving safe care and treatment, management oversight of the service, need for consent, person centred care, keeping people protected from abuse, staffing and the suitability of people working in the service.
Follow up
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 of 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.