This inspection took place on 7 November 2017 and was announced. The service is a domiciliary care agency which provides personal care to approximately 115 people living in their own homes in the West Sussex areas. The agency supports a range of people living with a variety of identified needs, including those who may be living with dementia, mental health, older people, younger adults, people living with physical disability and sensory impairment. People living with eating disorders or who may misuse drugs and alcohol may also be supported by this agency. The registered manager told us that the service was able to provide people with care at the end of their lives.Not everyone using South Coast Care Limited receives personal care services. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
There is a registered manager at this service who has been registered with the CQC since April 2013. A registered manager is a person who has registered with the CQC 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 is also the registered provider for this agency.
The agency was previously inspected by us in October 2015 when they were rated as providing a good service to people. However, during this inspection on 7 November 2017, we found that the registered manager was unable to sustain this level of good practice. We previously had concerns about this provider’s ability to run a good service. In January 2015 we rated this provider as inadequate overall, with breaches of regulation in eight areas. Two of these breaches resulted in us taking enforcement action against the provider. We had significant concerns about the quality of service provision and the provider’s ability to have clear oversight and regular monitoring of the service. Other concerns related to poor medicines management, lack of detail in people’s care plans and risk assessments to mitigate risks to people. Staff were not completing mandatory training and there was a lack of staff supervision and poor management understanding of the Mental Capacity Act 2005 and how this affected their provision of care to people.
In May 2015 we completed a Focused inspection to review the provider’s progress against the previous concerns. We found that the provider was still providing an inadequate service in relation to the assessment of risks and completion of appropriate risk assessments for people. People’s medicines were still not being managed safely. There had been some improvements in the provider’s quality systems and it was noted that medicines audits were being completed by the registered manager. Despite the service being rated as good overall in October 2015, in November 2017 we found that this had not been sustained. The registered manager was not completing any audits to monitor the quality and safety of the service provided to people.
People’s safety was compromised in some areas. Risks to people weren’t always clearly identified, assessed or managed safely and actions were not always recorded for care staff to be able to reduce the risks. Accidents and incidents were not always recorded appropriately and risks identified were not always assessed with sufficient detail to mitigate identified risk as part of the person’s care plan. Records relating to medicines for people weren’t always completed accurately. However, people using the service told us that staff administered medicines appropriately to them and that they felt safe.
Care plans did not always reflect people’s individual needs clearly and the specific support that would be required to meet people’s needs, choices and preferences were not clear in most care records seen.
There were enough staff to provide care to people. However, some people said that they did not know when they would be seen by staff and stated that the management of the service wasn’t always efficient. People knew how to raise a complaint if they needed to. The service had no records of complaints at the time of the inspection.
The management team did not have sufficient knowledge and understanding of how the Mental Capacity Act 2005 affected their provision of care to people. This may place people who lack capacity to make decisions at risk of not receiving the support they require in order for care to be provided in their best interests. People’s health was monitored in daily records. The agency used an electronic system which enabled the duration of calls and staff whereabouts to be tracked to support the safety of staff that may be lone working and to provide confirmation of the care people received.
Staff received training to cover a range of subjects including health and safety, medicines, moving and handling, safeguarding, and infection control. Some additional specific training had been listed within the staff training logs, which included training for people’s particular care needs. However, not all staff had completed the training required and there were gaps in staff training records. Staff had not all completed food hygiene or first aid training. This may result in people not receiving safe and effective care from suitably skilled and trained staff. Staff did not all receive regular supervisions and observed practice sessions. Staff were aware of how to report safeguarding concerns.
During the inspection we found that the provider had not submitted statutory notifications to the CQC when they are required to. The registered manager was not aware of their responsibilities and requirements under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009 to notify the CQC.
Quality audits of the service were not being completed when this inspection was conducted, but some people using the service could recall being asked for their views of the service. Records showed the registered manager communicated regularly with staff electronically using a secure system, regarding updates and changes staff needed to be aware of. Staff spoke positively about the management of the service and felt supported in their roles.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we have taken at the back of the full version of the 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.