Background to this inspection
Updated
31 December 2015
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.
The inspection took place on 13 October 2015 and was unannounced this was because we had received a number of concerns about the safety of people using the service and how the service was managed. This inspection was carried out by two inspectors.
Prior to our inspection we looked at the information we held about the service. This included statutory notifications, which are notifications the provider must send us to inform us of certain events. We also contacted the local authority to gather feedback and information they held about the service. We were made aware that the service has been suspended by the local authority since February 2015 and that the contract has since expired. We were informed the local authority were not funding any people using this service.
During our inspection we spoke with five people who use the service and four relatives on the telephone. We spoke with the owner and five members of staff. We reviewed the care records of ten people who use the service. We looked at records of how the service was managed this included staff records and monitoring records, staff schedules and a range of other records that related to the management of the service such as safeguarding’s, incidents and accidents documents.
Updated
31 December 2015
The inspection was unannounced and took place on 13 October 2015 in response to concerns that had been raised regarding the quality of care being provided to people by 1st Hand Care. At our last inspection in July 2014 we found breaches in the regulations relating to the care and welfare of people who use the service and assessing and monitoring the quality of service provided to people.
1st Hand Care is registered to provide personal care to people living in their own homes. At the time of our inspection the service was providing personal care to ten people.
There was a registered manager in post at the time of this inspection. 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.
There were not always enough staff to provide care because calls were not always at the times they were needed and calls were often cut short. The provider had not followed safe recruitment processes and employed staff without completing all the checks necessary to ensure they were suitable to provide care and support to people.
Care staff knew about how to protect people from abuse but the provider did not have an effective system in place and there was a risk that safeguarding concerns would not be raised with the local authority.
We could not be assured that people received their medicines as required because some people said they showed staff how to do their medicines. Staff had not received training in medicine administration nor had their competencies been tested by the provider.
People were not always supported by staff that had the knowledge or training they needed to be able to provide good care to people.
People we spoke with told us staff asked for their consent before providing care. People told us regular staff were caring but this was being undermined because staff were rushed. People said that because of the lack of continuity of staff; staff were less aware of their individual needs. People told us that they were treated with dignity and respect particularly when providing personal care.
People were not clear how to raise a concern or complaint with the provider. The provider did not have an adequate process in place to monitor record and investigate complaints.
We found that there were no processes in place to identify and monitor trends. The provider was not able to evidence that they had any quality assurance processes in place.
During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what regulatory action to take to address breaches in regulation. Once completed we will publish our actions.
The overall rating for this service is ‘Inadequate’ and the service is therefore 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 enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling 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.