Verity Healthcare - Waltham Forest

Verity Healthcare – Waltham Forest is a domiciliary care agency. The service provides personal care and support to adults and children in their own homes. Not everyone using Verity Healthcare – Waltham Forest receives 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. At the time of our inspection there were three children and one adult using the service.

The provider is also registered to provide another regulated activity, Treatment for Disease, Disorder and Injury but as recorded at the last inspection they advised us they were not delivering this at the time of our inspection and had not done so since the last inspection.

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

Improvements had been made since the last inspection in a number of areas in relation to the oversight and monitoring of the quality and safety of the service.

However, in some areas of training, staff did not always receive training in line with best practice requirements and guidance.

There was an absence of a robust system of oversight of staff training to ensure adequate checks on the validity of trainer’s qualifications met best practice requirements. The registered manager and a director of the service continued to state their training arrangements complied with guidance. However, they were unable to provide relevant evidence to assure us of this. We have referred our concerns to the relevant authorities.

Most risks were assessed and there were suitable risk management plans, but one risk assessment contained inaccurate information. An amended risk assessment was sent to us following the inspection.

Records related to people’s care were held across different phone apps and written records and it was difficult to be certain if staff were always guided about where to find all the information about people’s care. The provider recognised this and told us they were working to address this

People told us they felt safe using the service. Staff understood how to protect people from harm and how to raise concerns. The registered manager understood their role and responsibilities in relation to safeguarding adults.

There were enough staff to meet people’s needs and they received their care as planned. Safe recruitment practices were followed.

People told us staff followed good infection prevention practice, including the use of personal protective equipment, (PPE). Staff had received training on infection control. People were supported to maintain a balanced diet.

People's needs were assessed before they started using the service and they had a personalised plan for their care which reflected their individual needs and preferences. Staff told us they were supported in their roles through training and regular supervision.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they had the same small staff team who knew them well and they liked. People were complimentary about the staff who supported them. They told us they were treated with care, consideration dignity and respect.

People received care from staff who knew them well and respected their diverse needs. People told us they were involved in making decisions about the support they received and knew how to complain if they needed to.

Staff were positive about the support they received from the provider and registered manager. They told us they understood their roles and the registered manager was available and approachable.

People were complimentary about the service and told us they were consulted and involved in giving feedback through surveys or telephone calls.

There was a system to monitor other aspects of the quality of the service and identify any learning to make improvements. The provider showed us a new electronic system they were in the process of developing which they said would bring further improvements.

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 inadequate, (published 3 December 2021)

At this inspection we found improvements had been made but further improvements were needed.

At our last inspection we recommended that the provider consult best practice guidance in relation to the recording of medicines administration and risk assessments. At this inspection we found these recommendations had been acted on.

This service has been in Special Measures since 3 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Verity Healthcare - Waltham Forest on our website at www.cqc.org.uk.

The overall rating for the service has changed from Inadequate to Requires Improvement based on the findings of this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to staff training and the quality monitoring of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

We received negative feedback from people and their relatives about the service. There were numerous occasions where people who required two care workers only had one care worker and this was also confirmed when we looked at care records.

We also received negative feedback from people and their relatives that care worker punctuality and consistency was not always reliable. This had a negative impact on the quality and safe delivery of care.

People and their relatives provided mixed feedback about the management of the service, with an overwhelming emphasis on poor communication and unprofessionalism, especially in relation to one of the registered managers. Feedback about this registered manager was that they were at times aggressive and rude and this impacted their experience of using the service negatively. Feedback from professionals such as the local authority was also that one of the registered managers was aggressive and difficult to work with. As part of the factual accuracy process we were provided with a service user survey report which showed the steps the provider planned to take where the response to their survey was less than positive, albeit this was the in the minority.

We found that the registered managers were open to having discussions about our findings, during the inspection, in a professional manner. However, as we identified more concerns, the registered managers cooperation decreased. They showed a lack of accountability when we raised concerns, placing the blame on others, including service users and their families and relatives.

The provider was not routinely notifying us of notifiable events without delay.

We have made recommendations about medicines and risk assessments.

We found multiple breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Rating at last inspection

The last rating for this service was Good (published 4 June 2019).

Why we inspected

We carried out this inspection due to an increase in whistleblowings, complaints and safeguardings. The inspection was also prompted in part due to the increase of concerns including concerns about the management of the service.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified multiple breaches of regulation. These were in relation to staff deployment and the overall management of the service.

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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 6 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.

Verity Healthcare – Waltham Forest is a domiciliary care agency.

The service provides personal care and support to people from various client groups, including older people, people with physical and mental disabilities, sensory impairment and younger adults, living in their own homes.

Not everyone using Verity Healthcare – Waltham Forest receives 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 our inspection there were six people using the service.

People’s experience of using this service:

People and their relatives told us they felt safe with staff.

People were safeguarded against harm and abuse by staff who were trained in safeguarding and understood their responsibilities to report any suspicions of abuse.

People’s medicines needs were met because robust systems were in place to manage medicines safely.

People were protected from the risks of infection by staff who followed safe infection control practices.

The provider ensured that enough and suitable staff were deployed to meet people’s needs.

People received care from staff who were trained and felt supported to efficiently carryout their role.

People’s needs were assessed before joining the service to ensure that staff were appropriately trained and skilled to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care plans were individualised, and staff provided personalised care.

People and their relatives told us that staff treated people with dignity.

People were involved in their care and their independence was encouraged.

People and relatives knew how to raise concerns. The provider had responded appropriately when a concern was raised.

People and relatives told us they felt the service was managed well and they would recommend the service to friends and relatives.

People were asked their views about the service to help improve the quality of care delivery.

There were systems in place to effectively monitor the quality and safety of the service.

We have made a recommendation about ensuring staff follow guidance from healthcare professionals.

Rating at last inspection:

Requires Improvement (report published on 13 April 2018).

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received we may inspect sooner.

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

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Verity Healthcare – Waltham Forest is a domiciliary care agency. It is registered for personal care and treatment of disease, disorder or injury. At the time of this inspection it was providing personal care to people living in their own houses and flats in the community. At the time of the inspection it was providing a service to 12 people.

There was a registered manager at this service. 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 medicine risk assessments were insufficient and did not inform staff of the individual support needs and risks faced by people they supported to take medicines. Risks people faced had been identified, but the measures in place to mitigate them were not clear. Recruitment processes were not robust. Care records were not always accessible and complete. The governance and audit arrangements had failed to identify or address the range of concerns found during the inspection.

We identified breaches of three regulations. 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.

Staff received support with regular training and supervision. Staff received appraisals however appraisal records were not always robust. .

Staff and senior management had a good understanding of the Mental Capacity Act 2005 (MCA). MCA is legislation protecting people who are unable to make decisions for themselves. We saw people were able to choose what they ate and drank. There were sufficient numbers of staff employed by the service. Medicines were administered and recorded safely.

People who used the service and their relatives were positive about the staff and told us they were caring. People and their relatives told us they were involved in the planning of their care. We found that care plans were in place which included information about how to meet a person’s individual needs.

Staff, people and their relatives told us senior management were approachable and accessible. The service had various quality assurance and monitoring mechanisms in place. These included surveys, audits and staff meetings.

Verity Healthcare – Waltham Forest is a domiciliary care service providing personal care to people in their own homes. They are also registered to provide Treatment for Disease, Disorder and Injury but were not delivering this at the time of our inspection. They were providing support to approximately 60 people at the time of our inspection.

The service had two registered managers, one for each regulated activity. 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.

People told us they felt safe, and received good care when they had regular care workers. However, other people told us they received care from lots of different care workers and this affected how safe they felt and the quality of their relationships with care workers.

Only one third of staff had been trained on safeguarding adults from abuse. Records showed that investigations into allegations of abuse had not been conducted in line with safeguarding best practice and local authorities told us they found the provider was very defensive during safeguarding investigations.

Risk assessments relating to risks people faced while receiving care were not complete and did not address all risks faced by people during care. Risk assessments were not completed before people started to receive a service.

People were supported to take their medicines by staff from the service. Records did not show that medicines were managed in a safe way.

The service checked that staff were suitable to work in a care setting by completing criminal records checks. Recruitment records showed the service was not always following its own recruitment practice. We have made a recommendation about recruitment.

Care plans were task focussed and did not contain details of people’s preferences. They told staff where they were involved in supporting people with eating and drinking, but did not include details of people’s dietary needs and preferences. We have made a recommendation about meeting people’s dietary needs and preferences.

Staff gave us mixed feedback about the support and training available to them. Records of training and supervision were inconsistent and did not show staff had received the support and training they needed to perform their roles. We have made a recommendation about staff training and support.

Records regarding people’s capacity to consent to their care were not clear. People had not clearly indicated their consent to their care plans.

The service recorded people’s religious beliefs and cultural backgrounds. The service provided care workers who reflected people’s cultural needs where they were able. The service did not explore people’s relationships or sexuality in assessments or care plans. We have made a recommendation about supporting people who identify as lesbian, gay, bisexual and transgender.

The service had responded to complaints made. The service’s complaints policy was not appropriate for the service. We have made a recommendation about complaints.

People and staff gave us mixed feedback about the leadership and management of the service. While some people and staff told us management were accessible and responsive, other people and staff found them inaccessible and unresponsive.

Quality assurance and audit mechanisms had been ineffective as they had not identified or addressed issues with the quality of the service.

We have identified breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will update this report with our regulatory response.

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 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.