Background to this inspection
Updated
5 August 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 23, 24, 25 and 27 May 2016 and was unannounced.
The inspection team consisted of one inspector, a specialist advisor with knowledge of this type of service, and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection we reviewed the information we already held about the service. We reviewed notifications and safeguarding alerts. We reviewed the weekly action plan that the provider had been submitting to us regarding their progress since our last inspection which took place in October 2015. The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also spoke with the local authority commissioning and adult safeguarding teams and sought feedback from the local Healthwatch.
During the inspection we viewed the care files of 17 people who used service. We reviewed 12 staff files including records of recruitment, training, supervision and appraisal. We spoke with 11 people who used the service and four relatives. We spoke with 15 members of staff including the nominated individual, the registered manager, the senior coordinator, an administrator, a typist, two care coordinators, two field care supervisors, a trainer and five care workers. We reviewed incident reports, complaints and safeguarding records from the last six months. We reviewed various policies and documents including feedback from staff and people who used the service and other records relevant to the running of the service.
Updated
5 August 2016
The inspection took place on 23, 24, 25, and 27 May 2016 and was unannounced. The last inspection took place in September 2015 when the service was rated inadequate and placed in special measures. Following our last inspection the service had been issued with three warning notices regarding person centred care, safe care and treatment and good governance.
The service is a large domiciliary care service providing personal care to people in their own homes. At the time of our inspection they were working with 178 people.
The service had a registered manager in post. A registered manager is a person who had 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.
Care plans and risk assessments lacked details and did not contain the information required to provide safe care that met people's needs. Medicines were not managed in a safe way and staff did not have the information they needed to support people with their medicines. Assessments of people's needs and associated care plans had been poorly completed. People and staff told us care plans were out of date and did not contain the information needed to provide good care. The provider’s policy was for care files to be updated annually, but files had not been amended when people’s needs changed before a year had passed.
Records did not clearly record people's involvement in decisions relating to their care. Consent was not always clearly recorded in line with legislation and guidance. Care plans contained limited details about people's preferences. People were not asked about their sexuality and so were not given the opportunity to discuss if this affected their care preferences. We have made a recommendation about supporting people who identify as lesbian, gay, bisexual or transgender.
Where the service supported people to have their nutrition and hydration needs met, this was not clearly recorded and staff did not have the information they required to meet people's needs. When people required access to healthcare professionals, the service provided this. However, when staff were required to monitor people's health conditions they did not have the information they required to do this effectively.
People and their relatives provided mixed feedback about the attitude of staff. People said they felt safe and cared for by their regular carers. However, they did not feel that all staff had a positive attitude and did not think all staff knew how to perform their roles.
Staff completed a comprehensive induction before they started working in the service. However, on going training and support was insufficient to ensure they had the knowledge and skills required to perform their roles.
The service had a robust complaints policy and records showed that individual complaints and concerns were responded to appropriately. However, there was no analysis of complaints and no record that lessons were learnt in response to feedback.
The quality assurance and audit systems in place were ineffective. They did not address issues identified with the quality of work completed by the service.
We found five breaches of the regulations. We have taken enforcement action against the provider and will publish an updated version of this report when all legal appeals processes have been exhausted.
This provider is in special measures. This inspection found that there was not enough improvement to take the provider out of special measures.
CQC is now considering the appropriate regulatory response to resolve the problems we found.