Archived: Cura Heart Wokingham

Updated 17 August 2017

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 provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the office. This inspection was carried out over one day on site, with a second day being used for telephone interviews and was completed by one inspector.

Prior to the inspection the local authority quality team were contacted to obtain feedback from them in relation to the service. As this was the first inspection of the service we were unable to refer to previous inspection reports. However, we used any local authority reports and notifications to assist with planning the inspection. Notifications are sent to the Care Quality Commission by the provider to advise us of any significant events related to the service, which they are required to tell us about by law. As part of the inspection process we also looked at the 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 had received the PIR for Cura Heart Wokingham, and used the registered manager’s views on the service prior to visiting, to help inform the inspection process.

During the inspection we spoke with two members of staff, including the registered manager and one care staff. We attempted to make contact with the other two care staff on several occasions however were unsuccessful in speaking with them. We spoke with three people who use the service and three relatives of people who were authorised to speak with us on their behalf. In addition we received feedback from four professionals from the local authority.

Records related to people’s support were seen for six of the ten people who use the service. In addition, we looked at a sample of records relating to the management of the service. Staff recruitment and supervision records for the three care staff and the administrator were reviewed.

Updated 17 August 2017

This inspection took place on 5 June 2017 and was announced. Cura Heart Wokingham provides domiciliary care services to people within their own homes. This includes a specific number of hours of support to help promote the person’s independence and well-being. At the point of inspection 10 people using the service received support with personal care. Cura Heart Wokingham is a newly registered service. The service was registered with the Care Quality Commission in December 2016, and began operating in January 2017.

The service has a registered manager. 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 registered manager also holds nominated individual responsibility as he is one of the two directors of Cura Heart Wokingham.

People were not always kept safe. Whilst staff were able to recognise signs of abuse, they were unable to identify what protocols to follow if they had any concerns. As a result notifications were, not completed when safeguarding incidents occurred. The service did not complete or record any investigations to ensure that all steps were taken to prevent any abuse happening again

Risks were not assessed to keep people safe. This meant that staff did not always know how to manage a risk should one occur.

People were not supported with their medicines by suitably trained, qualified and experienced staff. Not all staff who administered medicines had received training in medicine management. There had been no check of staff competency prior to administering medicines. Some people had not received their medicines as prescribed. The impact and risk of this was neither reported nor assessed by the service. Staff were trained in medicine management by the registered manager. He did not have the necessary qualifications or skill basis to ensure competent training was provided.

The service did not have systems in place to ensure sufficient suitably qualified staff were employed to work with people. Systems were not in place to ensure that staff were safeguarded from harm to their health. The provider did not seek information related to staff’s physical and mental health prior to commencing employment.

People received care and support from staff who did not have the necessary skills and knowledge to care for them. Mandatory and specialist training had not been completed by all staff working with people, even though information provided by the registered manager prior to the inspection stated this had been completed. Staff did not have an understanding of the Mental Capacity Act, and did not know how to use the principles of this when working with people. People were not supported to have maximum choice and control of their lives. Staff may not have been able to support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

People told us communication with the service was not good and they did not feel listened to. Complaints were not investigated and not responded to. There was no evidence of any concerns being fully documented by the service, irrespective of issues being raised by the local authority.

People did not receive care that was person centred or tailored to meet their individual needs. Care plans did not contain sufficient information on how to support people, and were not reviewed. Calls were not completed for the full duration of the scheduled call. Staff were not allocated travel time between calls, which resulted in calls being shortened.

The service was not well-led. The registered manager did not have an overview of the service. Audits were not completed, nor the importance of these understood by the registered manager, as being an integral part in maintaining and developing the service. Information provided to the CQC was inaccurate and not reflective of the service.

We found a number of breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff were not provided with appropriate training, competency assessment and performance appraisals as were necessary for them to carry out the duties they were employed to perform. The provider had not established an effective system that ensured their compliance with the fundamental standards. The fundamental standards are regulations 8 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, 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 or overall, we will take action in line with our enforcement procedures. 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.