Santos Care Limited

Santos Care Limited is a small domiciliary care provider. At the time of our inspection there were 15 people using the service.

People’s experience of the service and what we found:

Care plans and risk assessments lacked detail, peoples wishes and preferences were not always recorded to ensure care was provided in a way they chose or wished. Some risk assessments were generic and not person centred. Risk assessments did not always contain information on how risks were managed or mitigated.

Health management plans were generic and contained details which could mislead staff in relation to what support fell within or outside of their competencies.

Care plans held conflicting information as to the care that was to be provided. What was written in the care plan did not always reflect the actual care taking place.

The provider had ineffective systems and processes in place to ensure full and effective oversight of the service and the quality of care provided.

People and relatives were not confident that staff were trained and competent in completing tasks as part of their or their relatives’ care.

Best interest meeting records did not capture full details of the decision to be made or why it was needed, also records did not always demonstrate all the relevant options had been explored.

Where people took medication, it was not clear who was responsible for the management and administration of medication.

People consistently received late calls.

Rating at last inspection and update

The last rating for this service was Requires Improvement (Published 26 April 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At our last inspection we recommended improvements to be made in regulation 9 (Person centred care, regulation 11 (Consent), regulation 12 (Safe care and treatment), regulation 17 (good governance), regulation 18 (Staffing). A warning notice was issued for the breach of regulation 12 (Safe care and treatment and regulation 17 (good governance). At this inspection we found the service remained in breach of regulations.

Why we inspected

When we last inspected Santos Care Limited on 7 March 2023 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

You can see what action we have asked the provider to take at the end of this full report. Please see the Safe, Effective, Responsive and Well led sections of this full report. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Santos Care Limited on our website at www.cqc.org.uk.

Enforcement [and Recommendations]

We have identified continued breaches in relation to Regulation 9 (Person centred care), Regulation 11 (Consent), Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

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

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 time frame 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.

Santos Care Limited is a domiciliary care agency providing personal care to people living in their own houses and flats. At the time of our inspection, the service was supporting 20 people with personal care.

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

Risk assessments were not always in place to guide staff how to manage clinical risks to people. People told us they were not always supported by the appropriate number of staff to meet their needs. People’s medicines were not always managed safely. People’s medicines records were not always completed accurately and there were no protocols in place to guide staff when to administer ‘when required’ medicines. Staff did not always know when to raise concerns regarding people’s safety. Accidents and incidents were recorded inconsistently so trends could not always be identified to reduce the risk of reoccurrence.

People’s assessments were not always detailed and did not always guide staff how to meet people’s diverse needs. People told us staff were not always well trained although records indicated they had completed an induction and were up to date with training. Mental capacity assessments were not completed when needed. 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. People’s care plans were not always consistent and were not always reviewed when people’s needs changed.

Staff did not always have sufficient English language skills to communicate effectively with people and their relatives which placed them at risk. Calls were often late and people did not always have their staff preferences met. Complaints were not always managed and addressed consistently.

Systems in place to check the quality of the service failed to identify errors in people’s medicines records. Quality checks did not identify where risk assessments and mental capacity assessments were not in place and where there were inconsistencies in documentation. Systems in place were not effective in ensuring people’s care calls were on time. The registered manager and staff did not always understand the issues and risks facing the service. People and relatives engaged with questionnaires and feedback calls but told us action was not always taken to address any concerns they raised.

People were supported by staff who knew how to prevent and control infection. People were supported to prepare meals of their choice by staff. Staff informed relatives where there were any health concerns. People and relatives told us staff were kind and caring and treated them with respect. Staff supported people in a way that preserved their privacy and dignity. Staff supported people to maintain their independence. Staff told us the registered manager was supportive and approachable. The registered manager understood the duty of candour.

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

Rating at last inspection

This service was registered with us on 22 November 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about neglect, moving and handling practices and concerns regarding late calls and staff training. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the assessment of risk and medicines administration, consent, staffing, providing care in line with people’s needs and preferences and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

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.