Archived: Evoke Home Care

Updated 4 May 2018

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 was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The inspection team consisted of two adult social care inspectors.

Prior to the inspection we looked at information we had received about the service since the last inspection. This included information passed to us by the local authority. It also included information from people who were using the service or their family representative and weekly information we had been asking the registered provider to submit. We were doing this because we wanted to monitor how the service was performing. No notifications had been submitted to CQC since the last inspection. A notification is information about important events which the service is required to send us by law. Five new safeguarding concerns had been reported to the local authority since September 2017.

During the inspection we spoke with the registered provider and other members of his family who have been assisting him since the last inspection. We spent time with the acting manager the care coordinator and the office manager. We spoke with eight care staff, 11 people who received a service in their own home and seven relatives. We looked at 21 people’s care records, six staff recruitment files and training records, key policies and procedures and other records relating to the management of the service.

We received feedback from three social care professionals during the inspection period. We asked them how confident they were in the service. They told us what their views where of the service since the last inspection and we have included their comments in the main body of the report.

Updated 4 May 2018

This inspection started on 15 February 2018 and was unannounced. The service was previously inspected in September 2017 and was rated Inadequate. This was because there were eight breaches of regulations. Major concerns were around the safety of the service and the management and leadership arrangements. The service was placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

At the time of this inspection the service was providing support to 27 people who lived in their own homes, of these 23 people were receiving the regulated activity of personal care. Another four people received domestic assistance or companionship and this part of the service does not come within the remit of the registration. The service was provided to people who lived within the Bristol area. The service employed 14 care staff and three office staff.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 (part 4). You can see what action we told the provider to take at the back of the full version of the report.

There were insufficient care staff to meet the number of people being supported by the service at the time of the inspection. The service were using agency staff to fill the shortfall but people were not happy with the number of their care calls covered by unfamiliar staff. People did not always know which member of staff was planned to cover their care calls and they did not like this.

The service continued to not follow safe recruitment procedure which meant the potential for employing unsuitable staff placed people using the service at risk. The service had failed to act on the findings from the last inspection.

People were not receiving a person-centred service. The service provided was based upon the resources the service had to offer and did not always take account of agreed timings and length of care calls. Whilst there had been some improvement in late, missed and shortened calls people were still not satisfied with the service they were provided. Relatives described the service as unreliable and a great cause of stress for them. The service had failed to act on the findings from the last inspection.

The training arrangements for new care staff and for the existing staff team did not ensure they had the necessary skills to provide a good service. We found that the training for new staff being inducted had been signed off in one or two days and a check on learning had not been carried out to check their learning. Sufficient improvements had not been made to ensure existing staff we all up to date with their mandatory training. The service had failed to act on the findings from the last inspection.

The registered provider did not have a system in place to handle and act upon any complaints made about the service. People and their relatives told us about concerns and complaints they had raised but these were not logged. There was no record of any actions taken. The service had failed to act on the findings from the last inspection.

The registered provider and all other personnel brought in to make improvements to the service did not have sufficient insight to the legislative requirements in delivering a care service. The registered provider was unaware of the need to display their quality rating poster so prospective service users or staff could judge whether they wanted to use the service. The registered provider had failed to keep their statement of purpose up to date. The statement of purpose sets out the aims and objectives of the service so that people know what to expect.

The registered provider did not quality assurance systems in place to check on the quality and safety of the service. This meant the registered provider was not aware of how the service was complying with the Health and Social Care Act 2008 and could not make improvements. The service had failed to act on the findings from the last inspection.

All care staff were expected to complete safeguarding adults training and records showed all staff were up to date with this training. The service was still the subject of on-going organisational safeguarding monitoring but no further concerns had been raised since the last inspection. The acting manager and senior staff were still waiting to attend local authority safeguarding training.

As part of the care planning process a range of risk assessments were undertaken to ensure people being supported and care staff were not harmed. All work activity tasks were risk assessed including moving and handling tasks.

Where people needed support with their medicines, a plan of care detailing the exact help they needed was in place. Care staff were supplied with personal protective equipment to enable them to prevent any infection being spread. Where people needed support with eating and drinking, or for contacting health care professionals, they were supported by the care staff. The level of support the person required was detailed in their care plan.

There was a lack of consistency in the effectiveness of the care and support provided because people received assistance from many different staff. People were not provided with a person centred service that met their assessed and identified care and support needs. It was the practice they were provided with whatever resources could be arranged on a given day. The service provided was not effective and people’s relatives had to pick up the shortfall.

Each person had a well written plan of care written, however, the service they received did not match these care plans. The plans were detailed and provided a good pen picture of the person and their family and working life but the way the service was arranged did not enable the care staff to deliver that care and support.

Care staff asked people to give verbal consent before they offered any assistance. They only received minimal training in respect of the Mental Capacity Act 2005.

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