Archived: Saffron Care Agency

Updated 14 September 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 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.

We received concerns from people who use the service, staff, and the local authority. Concerns related to late visits and people being rushed during their visits, lack of staff training, medicines not being administered appropriately, poor communication and lack of response to complaints, and poor staff attitude. In response to those concerns we brought forward this unannounced inspection. Inspection site visit activity started on 17 May and ended on 30 May 2018. It included speaking with people and their relatives on the telephone, visiting people in their own homes with care staff, and speaking with staff. We visited the office location on 17 and 30 May 2018 to see the manager and office staff; and to review care records and policies and procedures.

Two inspectors carried out the first day of inspection at the office. One inspector carried out six visits to people in their own homes on 21 May 2018. Two experts by experience made telephone calls to people who used the service and their relatives on 22, 23 and 25 May 2018. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was care for older people. During this inspection, we spoke with 29 people and 7 relatives.

We reviewed the concerns we had received. We looked at the notifications we received. 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.

During the inspection, we spoke with 18 staff, the compliance manager, the office manager, and the registered manager (who was also a director of the provider organisation). We reviewed a compliment from one healthcare professional. We looked at 12 care plans including risk assessments, visit records, and records relating to medicines. We looked at 12 staff files. We checked how complaints were managed and quality was monitored.

Updated 14 September 2018

This comprehensive inspection took place between 17 and 30 May 2018, the first day was unannounced. We last inspected this service in September 2017 where it was rated 'Inadequate’ overall. At that inspection, we identified nine breaches of regulation. The Care Quality Commission (CQC) took enforcement action against Saffron Care Ltd and imposed a condition on the provider’s registration. This required the provider to send us fortnightly and monthly reports on the areas of greatest concern and risk. This also included a requirement that the provider must give us information about the actions taken in response to any issues.

We met with the provider to confirm what they would do and by when to improve the service. The number of people who used the service had decreased from 260 to 156 people. The registered manager was receiving support from the organisation who sub-contract packages of care to them and the local authority quality assurance and improvement team (QAIT). Despite this support, this inspection has shown widespread and significant shortfalls, and some deterioration, in the service. The only improvement made, that has had a positive impact, was to staff recruitment.

Saffron Care Agency is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults. Not everyone using Saffron Care Agency receives a regulated activity; 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. At the time of this inspection the service was providing care and support to 156 people.

The service had a registered manager who was also the provider. 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 received concerns from people who used the service, staff and the local authority. In response to those concerns we brought forward this unannounced inspection. Prior to us starting this inspection the local authority placed the service back into a multi-agency safeguarding process due to the concerns they had received. We also shared our concerns with the local authority commissioners and safeguarding team. Concerns related to late visits and people being rushed during their visits, lack of staff training, medicines not being administered appropriately, poor communication and lack of response to complaints, and poor staff attitude.

People who used the service were still not safe. We looked at people’s visit records and found staff were not always recording the time they arrived and left visits. This meant the registered manager could not assure us that visits were being carried out as agreed. We found examples of people being rushed, not getting their full visit time, and care being missed. Incidents that should have been reported as safeguarding alerts had not been sent to the local authority without delay. People did not always receive their medicines as prescribed.

When people’s regular staff were not working, staff who carried out visits didn’t always know people or how to meet their needs. We found examples of staff being expected to use equipment when they had not received appropriate training. This included training in how to put on support stockings, using a hoist, catheter care, and supporting people with their oxygen and nebulisers. Some people told us they felt unsafe. One person said “I have issues relating to my safety and the training or lack of training of carers on using my hoist”.

People told us when their regular care staff were not working, they did not receive the same caring service. One person commented “Some of them are very aggressive, some patronising”. People’s preferences were not always listened to and respected. Where people had asked for certain staff not to support them, this was not always respected. Several people told us some staff who visited them didn’t speak to them. One person told us this made them feel sad as they liked to have a chat.

People’s complaints were still not taken seriously, explored thoroughly or responded to. We found complaints that hadn’t been recorded correctly. Complaints records did not contain clear information relating to investigations, outcomes and action taken in response to the complaint. The compliance manager had delegated actions to team leaders and field trainers to resolve issues. We found these actions had not been taken.

Some people still didn’t receive person-centred care because some staff were not aware of their needs before visiting them for the first time. The management had discussed ways of getting information out to staff in September 2017 but staff told us they still didn’t receive information. People’s care plans were still not always reviewed and updated to reflect their current needs. Staff told us there was not enough time for team leaders to update care plans due to them carrying out other duties.

People were still placed at risk because there continued to be a lack of leadership, governance and managerial oversight of the service. People and their relatives told us the service was not well managed. Comments included “This company is not well led. You can talk to (registered manager’s name) and he promises things will be sorted out and they aren’t” and “The service isn’t learning. The company is poor and lets down some of the good carers they have”. Other people told us they were happy with service they received and felt some improvements had been made.

People and staff told us there was still a lack of communication. Staff we spoke with were passionate about their work and knew changes needed to be made but were frustrated by the organisation. Staff commented “Things have got worse not better” and “it’s so badly run”. Staff gave us examples of being spoken down to and not treated equally. When staff had raised concerns these were not taken seriously and action was not taken. Staff told us this had impacted on their morale and staff had left the service as they were unhappy.

The registered manager said he would take actions following the previous inspection. They told us a number of actions had been completed but we found there were ongoing issues which are described throughout this report. Quality assurance systems did not ensure people’s individual care needs were met, risks were minimised or care was delivered to keep people safe.

You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service continues to be 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.