Archived: Home from Home Care Services Limited - 168 Burton Road Derby

Home from Home Care Services Limited - 168 Burton Road Derby is a domiciliary care agency providing personal care. At the time of our inspection, 28 people were being supported by the agency.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People were not protected from the risk of harm due to inadequate safeguarding procedures and poor assessment and monitoring of risk. People were at risk of infection from poor infection control practice. People did not receive their medicines as prescribed. Staffing levels were inadequate to meet people’s needs and staff were not always recruited safely. There was a failure to learn lessons following incidents and investigations.

People’s care was not planned and reviewed in line with national guidance. Staff training was not effective and left people at risk of harm. People were not always supported appropriately with their nutrition and hydration. Staff did not work collaboratively with healthcare professionals to promote people’s health and wellbeing.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s dignity was not respected, and they were not always treated with kindness and respect.

People’s independence not always supported, and they were not consistently involved in their care.

People were not supported to make complaints, and these were not always recorded and reviewed. Care was not planned in a person-centred way and people's interests, relationships, choice and control were not promoted. People’s communication and end of life care needs were not understood or respected.

There was a lack of management and oversight by the registered manager and provider. The registered manager was not part of the day to day running of the service. There was a negative blame culture which did not have people at the heart of the service and there was a lack of transparency within the service. Engagement with people, the public and staff was minimal. There was poor cooperation with external stakeholders and healthcare professionals.

Following our inspection, due to the level of risk, the local authority made arrangements for people to received support from alternative care providers.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 March 2019) and there were two multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified 11 breaches of regulations at this inspection. These relate to safeguarding people from abuse, safe care and treatment, safe employment of staff, staffing levels and training, governance and oversight of the service, action with complaints and a failure to provide person-centred care and respecting people’s dignity

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.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 overall rating for the service awarded at the previous inspection which took place on 27 July 2017 was ‘Requires Improvement’. The provider was not meeting two of the regulations that we checked and was in breach of Regulation 17 and 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to take action to make improvements to promote people's safety and to improve systems and processes to monitor the quality of the service. The provider submitted an action plan outlining their plan for improvements.

At this inspection we found further improvements were still required. This is the third consecutive time the service has been rated ‘Requires Improvement’. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive.

Home from Home Care Services Limited Services – 168 Burton Road Derby is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The service caters for older people with needs relating to dementia, learning disabilities, mental health, physical disabilities, and sensory impairment. The registered location is situated in Derby city, providing care to people around Derby. There were 19 people using this service at the time of our inspection.

At our last inspection during July 2017 the provider was not meeting all the regulations we checked. Recruitment procedures did not ensure all the required pre-employment checks were completed prior to staff commencing employment. We also found the leadership and management of the services and its governance systems were not robust. The provider was also required to make improvements under effective and responsive. At this inspection we found that the provider was still not meeting all the regulations we looked at and improvements were still required under safe, responsive and well-led.

The service had 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.’

We have made recommendations the provider implements procedures for late calls to ensure the risk of missed visits or late calls are minimised, keep medication training updated in line with relevant guidance and having procedures for renewing DBS checks in place.

The provider continued to have ineffective quality assurance systems which failed to identify area’s which required improvements.

There were processes in place for people to raise any complaints or concerns about the service provided. However, people did not feel listened to and complaints had not always been resolved to the complainant's satisfaction.

People told us they felt safe with the care provided by staff. Staff we spoke with understood their responsibility in protecting people from the risk of harm. Staff told us they had received training and an induction that had helped them to understand and support people.

Staffing levels were adequate to meet people’s needs who were currently receiving support from the agency. However, people raised concerns that they did not always receive their calls at the agreed times and when staff had been delayed they were not notified.

Staff had received training in infection control and were provided with the necessary personal protective equipment such as gloves to use when carrying out care and support tasks

Staff supported people to make decisions about their day to day care and support.

When needed, people were supported to maintain their dietary requirements. Staff we spoke with were aware of who to contact in an event of an emergency.

People told us that staff treated them in a caring way and respected their privacy and supported them to maintain their dignity. The delivery of care was tailored to meet people's individual needs and preferences. However, some people felt some staff were friendlier than others.

Home from Home Care Services Limited - 168 Burton Road Derby is a domiciliary care agency providing personal care. This included people living with dementia, older people, people with mental health and physical disability. At the time of this inspection there were 23 people who received personal care. The agency office is located close to Derby city centre.

There was a registered manager in post; they were also the service provider. The registered manager was not based at the Derby office which they visited a couple of times each month. A registered manager is a person who has registered with the Care Quality Commission. 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.

We found that the provider's quality assurance systems had not picked up the issues we identified at this inspection visit. This demonstrated that the management systems were not always effective in recognising areas which required improvements.

The provider's arrangements for staff recruitment were not always safe and did not ensure suitable people were employed. We found that all the required pre-employment checks were not in place before staff commenced employment.

People and relatives knew how to raise concerns. However some relatives felt that complaints were not always well managed and they did not feel listened to. This demonstrated that complaints were not resolved satisfactorily.

People were not happy that they were not always contacted by the office staff, advising them if staff were going to be late attending their call.

The Mental Capacity Act (MCA) 2005 (MCA) helps to ensure that people are supported to make their own decisions wherever possible. Where people were identified as not having capacity there were no records of best interest decision making to show the care and support provided was in the person’s best interests.

Staff told us the training received was adequate to support people. Staff told us they felt supported and that they received regular supervision.

People received appropriate support to manage their meals when required. This was done in a way that met with their nutritional needs and choices. People’s health needs were met, staff confirmed if they were concerned about people’s health they would notify the office or contact the relevant service as required.

People told us staff treated them in a caring way and respected their privacy. Staff supported people to maintain their dignity. People's independence was promoted.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Home from Home Care Services Limited - 168 Burton Road Derby provides personal care to people in their own homes in Derby. This included people living with dementia, older people, people with mental health and physical disability. At the time of this inspection there were 90 people using the service, which included 63 people who received personal care.

There was a registered manager in post; they were also the service provider. The registered manager was not based at the Derby office. Office staff told us the registered manager visited the office a couple of times each month. 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.

At our previous inspection on 24 July 2014 the provider was not meeting all the regulations that we checked. We asked the provider to make improvements to care records as they were either not in place or were not kept up to date. At this inspection we found that some improvements had been made and care plans were up to date. However, some care plans did not provide specific guidance for staff about how to provide care to meet people’s needs in the way they required and preferred.

Whilst staff told us that they felt supported by the office manager and coordinators, the leadership and management of the service and its governance systems were not robust. Systems to monitor and review the quality of some areas of the service people received were not in place.

People using the service and relatives told us they felt safe. Staff we spoke with understood their responsibility in protecting people from the risk of harm, however we had not been notified of all incidents of a safeguarding nature. Overall, staff were available to cover care calls, however care was not always provided at the agreed times and in a consistent way.

Recruitment procedures were not thorough. For example not all the required pre-employment checks were completed. This did not provide assurance suitable staff were employed to work with the people who used the service.

The provider did not fully understand their responsibilities under the Mental Capacity Act 2005. Staff were not clear about people’s individual capacity to make decisions.

Complaints were not always well managed and communication with the office had been inconsistent and not resolved issues satisfactorily.

People told us that staff treated them in a caring way and respected their privacy and supported them to maintain their dignity.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

People we spoke with told us that the carers understood their needs and that most of the carers were very good. One person stated 'some carers are nicer than others, but I get on with them all.' Another person stated 'I feel safe with the carers they are very good.'

Systems in place for responding to emergencies that could affect the delivery of peoples' care were not always effective.

Is the service effective?

Care plans were not always in place at the service or up to date. This meant that staff did not have sufficient information available to them to ensure people's individual needs were being met and that people were supported safely.

Is the service caring?

Care plans were not detailed. Care planning did not always take account of people's wishes, preferences and routines relating to their care to ensure they received personalised care that met their needs.

Is the service responsive?

People said that they could make a compliant if they wanted to.

Is the service well-led?

The provider was aware of incidents that affected the welfare, health and safety of people using the service, which required reporting to the Care Quality Commission.

Care planning was not adequately detailed to ensure people received personalised care that met their needs.

The majority of people that we spoke with were happy with the care provided. One person told us they were 'very satisfied', another stated that the provider was 'very good and that staff are 'nice to me, all very pleasant'. We found that care plans lacked detail and did not offer staff sufficient information to ensure that care needs were met.

Staff had received training in protecting vulnerable adults. Staff had an understanding of what abuse was and what action to take should they have concerns.

The provider had carried out sufficient pre-employment checks on staff members. This helped to ensure that staff were of good character.

The majority of staff were up to date with mandatory training in key areas such as moving and handling and first aid. However staff had not received regular supervision in line with the provider's guidelines.

The provider had quality assurance systems in place to help monitor the service provided.

Although appropriate action had been taken the provider had not informed the commission about all allegations of abuse.

One person who used the service stated that it was 'excellent'. Another told us that staff were 'cheerful and efficient'. People we spoke with felt that the staff listened to what their needs were and responded to these.

One professional stated that the service had been 'quite exceptional with one case'.

We found there was some concerns around care plans and pre employment checks carried out on staff members.