Archived: Stocksfield and Haltwhistle

Updated 22 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.

This inspection took place over five days on 20, 21, 26 and 30 June and 6 July 2017. The inspection was announced and we gave 48 hours’ notice. This was because the location provides a domiciliary care service and we needed to make sure key staff were available during our inspection.

The inspection team consisted of one inspector, one pharmacist inspector, one expert by experience and one specialist advisor. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The specialist advisor had a background in governance and quality assurance.

Before the inspection, 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.

Prior to the inspection we reviewed information we held about the provider, including previous inspection reports, notifications and concerns we had received. A notification is information about important events, for example, serious injuries or safeguarding concerns which the service is required to send us by law. We spoke with the local authority safeguarding team and commissioners for the service and also contacted Healthwatch. Healthwatch is an independent consumer champion which gathers and represents the views of the public about health and social care services. We contacted a variety of healthcare professionals, including two care managers from the local authority, one occupational therapist and two general practitioners. Where we received a response, this was used to support the planning of the inspection.

During our inspection we visited 14 people in their own homes and also spoke with six family members. We contacted 23 people and their relatives by telephone to ask them their views about the service.

We spoke with 20 members of care staff either by telephone, during visits with people or at a team meeting which we attended. We also spoke with the nominated individual, the managing director, the newly appointed manager, three care and support officers and three schedulers.

We reviewed 15 people’s care and medicine records. We looked at the personnel records of six care staff, which included recruitment and training documentation. We checked a range of documents in connection with the management of the service, including complaints, policies, and minutes of meetings. We also reviewed all quality assurance documentation.

Updated 22 August 2017

We carried out an announced inspection of this service on 20, 21, 26 and 30 June and 6 July 2017. At the last inspection in November 2016 the provider was not meeting Regulations 12, 17 and 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and these related to safe care and treatment, including medicines, good governance and the requirement to display a performance rating. They were also not meeting Regulation 15 of the Care Quality Commission (Registration) Regulations 2009 relating to notifications. Notifications are changes, events or incidents that the provider is legally obliged to send us within required timescales.

Since our last inspection in November 2016 the provider had sent us weekly action plans of how they were going to address the concerns and meet the regulations. This inspection was to ensure concerns had been addressed and that the provider was now meeting the regulations.

At the last inspection in November 2016 the overall rating for the service was required improvement with an inadequate rating in well led.

The overall rating for this service is now inadequate and the service has been placed in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the 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 or 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.

The provider was given short notice because the location provides a domiciliary care service into people’s homes. We needed to make sure that some notice could be given to people who used the service and also to ensure that key staff would be present at the provider’s offices.

Stocksfield and Haltwhistle provide personal care and support to people within their own homes in the communities of Hexham, Haltwhistle and the surrounding areas. The service is managed from an office on the outskirts of Stocksfield.

168 staff currently provide support to 268 people. The service is available for a wide range of people, including those who are older, those with mental health needs and those with more complex 24 hour healthcare requirements. The organisation on average completed 4452 calls per week, which provided people with 3272 hours of care, although this can vary due to the nature of the service. Many of these calls, for example, were to deliver personal care or administer people’s medicines but other calls may have been to complete housework or do shopping for an individual. The service also offered an enablement service, which provided people with support to remain as independent as possible, avoiding social isolation. This included help to visit shops or other venues important to them.

There was not a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated regulations about how the service is run.

There had not been a registered manager since the previous one retired. However, a new manager had been appointed a few weeks prior to our inspection and confirmed they were about to start the CQC application process. A new managing director had been appointed in November 2016 and since our last inspection a new nominated individual had taken over. We recognised that the new management team were dealing with issues that were historic in nature and had been embedded into the providers culture.

We had raised concerns in connection with the management of people’s medicines at the last two inspections we undertook at the service. There had been an improvement to the format in which medicines were now recorded. However, we continued to find discrepancies in the way in which medicines were managed. Out of the 14 people we visited, we found errors of some description in the way staff had managed people medicines in 11 of these people. We also found that the medicines policy had not been updated in line with National Institute for Clinical Excellence (NICE) guidance published in March 2017.

Accidents and incidents were recorded on the providers IT system, but we found that actions had not always been recorded and no analysis had been completed to learn from these or spot any trends forming. We asked for a copy of the provider's business continuity plan a number of times and were eventually sent it over a week after the initial request.

Staff had not always followed the requirements of the Mental Capacity Act 2005 (MCA) as records were not always in place to confirm any best interest decision’s had been made or to record if a person lacked capacity. Although we overheard people being asked for their consent before staff embarked on any personal care, we also found some people’s records did not specify as to why particular actions were followed by staff.

People had an assessment carried out when they started using the service. Care records had been updated and reviewed but not in all cases and therefore did not always give clear guidance. Care staff relied on relatives, people and other care staff who verbally shared information with them regarding people's personal care needs.

Surveys had not been completed to gain the views of people, their relatives or staff at the service.

Service audits to monitor and continually improve the service were not effective or were not in place. The shortfalls we found had not always been identified, particularly with regard to medicines.

People knew who to contact if they had a problem or complaint. Verbal complaints reported were logged on the provider's IT system. People told us that the provider looked into any complaints they had raised, but because sections were not always completed, we were not always able to see the outcome or the lessons learnt from each complaint or if indeed the complainant was satisfied.

Staff were recruited safely with a suitable induction completed. Staff had received a range of training, however, we were provided with a training matrix which was not accurate and therefore we could not be sure that staff had received the training reported.

At their supervisions and appraisals staff had the opportunity to discuss concerns and any further training needs. However, not all staff received regular supervision or an annual appraisal. Staff did not feel as supported in their work as they had previously been. However, we recognised that the provider had been subject to a number of staff changes, including within the management team, which was likely to have caused a feeling of unrest within the teams. This was now being addressed

People and their relatives felt safe, cared for and supported by care staff in their own homes. They told us they were treated with kindness and respect and were complimentary about the staff who supported them.

However some people were not happy as they did not have consistent care staff. Where there were missed visits the provider took action to try and prevent the risk of this happening again, although the systems used were not robust. The provider did not always inform people of changes to their rotas or planned care visits.

People were supported to eat and drink by care staff who knew what their food preferences were. The management team consulted health and social care professionals when needed.

The provider had sent the Commission notifications in line with their legal responsibilities.

We found four breaches in relation to Regulation 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to, the need for consent, safe care and treatment, staffing and good governance.

We made one recommendation in connection with the provider's rota system.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.