We undertook an announced inspection of Oasis Private Care (DCA) on 18 May 2016. We told the provider two days before our visit that we would be coming.Oasis Private Care provides personal live in care services to people in their own homes. At the time of our inspection 18 people were receiving a personal care service.
We had previously carried out an announced comprehensive inspection of this service on 6 August 2015 and identified a number of areas where improvements were needed to ensure that people were receiving care that was safe, effective, caring, responsive and well-led. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care Act 2008 (Registrations) Regulations 2014. This was because the service had failed to notify us of a safeguarding incident, The registered manager did not adequately monitor the quality of the service and that the registered manager and staff did not have a clear understanding of the principles of the Mental Capacity Act 2005.
We undertook this inspection to follow up the concerns that had been raised prior to our inspection and to check the service had made the required improvements from the inspection in August 2015. The improvements had not been made.
At this inspection in May 2016 we found there was a failure to recognise and report when people had been put at risk or had been subject to harmful situations, records relating to peoples care were not always accurate and that the registered manager was not adequately monitoring the quality of the service.
There was 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.
Following our last inspection in August 2015, the registered manager submitted an action plan that included: safeguarding update training for all staff, a review of company policies, the distribution of new safeguarding policy’s and local procedures to be distributed to people and staff, the review of care records, staff to be trained in personalised care, the review of quality monitoring and assurance policy to ensure compliance, service user satisfaction surveys to be collated and reviewed by management.
However during our inspection we found no evidence that these points had been actioned despite the original action plane stating that these would be completed within a specific timeframe and that some actions were already ‘In place’.
Services are required to by law to display their most recent ratings on their website and at the providers principle place of business. Ratings were not displayed on the services website or in the office.
At our inspection in August 2015 we identified that the registered manager had not raised a safeguarding alert. At our inspection on 18 May 2015 we found that the service was still falling to report safeguarding incidents within the service to the Care Quality Commission.
The registered manager did not routinely monitor the quality of service provided. This meant the registered manager could not identify patterns and trends that would allow them to improve the service. The service did not always have up to date and accurate records around the day to day management of the service.
Staff told us they received regular supervision. However records relating to staff supervision did not reflect that staff were receiving regular supervision. Records in relation to staff training were inaccurate.
The registered manager and staff did not demonstrate a good understanding of the principles of the Mental Capacity Act (MCA) 2005. Mental capacity assessments had not been used correctly and were incomplete.
We could not be confident the rights of people who lacked capacity were protected.
Risks to people were not always managed safely. Risk assessments did not always provide guidance for staff on how to reduce the risk.
Relatives we spoke with told us that staff were not deployed effectively and that the service was regularly late for its visits and that some visits were missed.
Risks to people were not always managed safely. Where people were identified as being at risk, assessments were not always in place or accurate. Care records did not always demonstrate that the service was responding to people’s individual needs.
We looked at the complaints file and noted one complaint was recorded for 2016. However, we could find no evidence this complaint was investigated. One person had contacted the registered manager to complain about staff punctuality. Whilst we saw the complaint had been closed the complaint had not been recorded and we could find no evidence it had been investigated.
People and their relatives knew how to raise concerns. However they did not always feel confident that action would be taken.
Some care records contained details of people’s personal histories, likes, dislikes and preferences and included people’s preferred names, interests and hobbies. However not all the care records were accurate or complete and did not always contain details of people’s preferences, likes and dislikes. People’s care plans were not always reviewed regularly.
People told us they benefitted from caring relationships with the staff and that staff were friendly, polite and respectful when providing support to people.
Relatives told us that people were supported to be independent. People told us staff sought permission and let them know what was going to happen before supporting them with personal care.
The overall rating for this service is ‘Inadequate’ and the service is in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel their 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 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.