Archived: People Matter Support Services Limited

People Matter Support Services Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Not everyone using People Matter Support Services Limited receives personal care. The Care Quality Commission only inspects the service being received by people provided with help with tasks related to personal care, hygiene and eating. It provides a service to older people, younger adults and also those with learning disabilities and/or those on the autistic spectrum. They have detailed in their statement of purpose that they can provide a personal care service to children aged up to 18 years, however, at the time of this inspection, the 14 people using the service were all adults.

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

The registered person had not established an effective system to enable them to ensure compliance with their legal obligations and the regulations. They had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided. The lack of robust quality assurance meant people were at risk of receiving poor quality care and, should a decline in standards occur, the provider's systems would potentially not pick up issues effectively.

People were not always protected from risks to their health and wellbeing. Risks to people who use the service were not always identified or addressed to reduce or remove risks. The registered person had improved staff training and recording of medicines. We have made a recommendation about staff who assess staff competence to handle medicines.

The registered person had not made sure staff employed were of good character and that all required information and checks were carried out. This meant people were at risk of staff being employed to work with them who were not suitable.

People were at risk of potential harm because the registered person had not ensured the staff providing the care had the qualifications, competence, skills or experience to do so safely. The registered person had not ensured staff were provided with appropriate training as was necessary for them to do their job safely and effectively.

People and their relatives felt the care and support they received helped them to be as independent as possible. They were happy with their care and felt the staff were kind and treated them with respect and dignity. People's needs relating to communication were not recorded in a way that met the Accessible Information Standard.

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 overall rating for this service was requires improvement (reports published 24 October 2018 and 25 April 2019).

The provider completed an action plan after the last comprehensive inspection in August 2018 to show what they would do and by when to improve.

After our focused inspection in December 2018 we found the provider remained in breach of the regulations and we imposed two conditions on their registration.

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

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, and the last focused inspection by selecting the ‘all reports’ link for People Matter Support Services Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to regulations 9, 12, 17, 18 and 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. People were not always protected from risks to their health and wellbeing; staff recruitment and training were not adequate to ensure people were safe or staff were competent and suitable for their roles; effective systems were not in place to ensure the service met the required fundamental standards of care. People's needs relating to communication were not recorded in a way that met the Accessible Information Standard.

We have imposed four conditions on the provider's registration and asked them to send an action plan regarding actions they will take to meet the Accessible Information Standard.

Follow up

We met with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor intelligence we receive about the service and we will return to visit as per our re-inspection programme. If any concerning information is received, 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 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.

At the last inspection on 21 and 22 August 2018 we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For three of those breaches we served requirement notices. They were for staff recruitment, medicines handling and staff training. We will follow up those requirement notices at our next comprehensive inspection.

The fourth breach of regulations was for regulation 17, Good Governance. We found the provider had not established an effective system that ensured their compliance with the fundamental standards. They did not have effective systems in place to enable them to assess, monitor and improve the quality and safety of the service provided. This meant they were not aware of, and not addressing, areas that needed improvement to ensure the quality and safety of their service. On 12 September 2018, as a result of our inspection in August 2018, we served a warning notice for that breach of regulations. Warning notices tell a registered person that they are not complying with a condition of registration, requirement in the Act or a regulation and will usually require a registered person to comply with that requirement by a specified date. In this instance we gave the registered person until 10 December 2018 to become compliant with regulation 17.

We undertook an announced focused inspection of People Matter Support Services Limited on 12 December 2018 to check if the provider had made improvements we told them to. We gave two working days' notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office.

This inspection was carried out to check that the warning notice had been met and that the registered person was compliant with regulation 17, good governance. We inspected the service against one of the five questions we ask about services: 'is the service well led?'. The ratings from the previous comprehensive inspection for the remaining four Key Questions were included in calculating the overall rating of requires improvement at this inspection.

The service had a registered manager as required. The registered manager is also the only director of the provider company and is the nominated individual. 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. The registered manager was available and assisted us during the inspection. In this report, for clarity, where we refer to the registered person we mean the provider/registered manager.

We found the service's rating for the well-led question had deteriorated to Inadequate.

The registered person had not taken the necessary action to meet the warning notice and become compliant with the regulations. Although new systems had been added, they were not effective in ensuring the registered person was meeting all fundamental standards. Systems were not effective in identifying areas that needed to improve. There was no effective system in place to enable the registered person to assess, monitor and improve the quality and safety of the service provided.

The registered person remained in breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

People Matter Support Services Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Not everyone using People Matter Support Services Limited receives personal care. CQC only inspects the service being received by people provided with help with tasks related to personal care, hygiene and eating. It provides a service to older people, younger adults and also those with learning disabilities and/or autistic spectrum disorder. They have detailed in their statement of purpose that they can provide a personal care service to children aged up to 18 years, however, at the time of this inspection, the 15 people using the service were all adults.

The service had a registered manager. The registered manager was newly registered in June 2017. The registered manager was also the director of the provider company, having taken over the company in October 2016. 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. The registered manager was available and assisted us on the first day of the inspection. She was not available on the second day due to a prior engagement and we were assisted by a member of the office staff.

People were mostly safeguarded from risks. However, there had been a number of safeguarding concerns raised with the local authority since November 2017. The areas of concern mostly related to care plans, risk assessments, staff files, staff training, staff supervision and spot checks. More recently concerns had been raised regarding missed calls. Actions were being taken to address the concerns and reduce risk in those areas. However, at the time of our inspection there was no effective system for the provider to ensure the service was fully compliant with the fundamental standards. There was also no system to assess, monitor and improve the quality and safety of the service.

Staff recruitment issues were identified during the inspection. For example, unidentified gaps in employment which had not been explained in writing and there had been no verification of reasons staff left previous employments with vulnerable adults. Where DBS checks highlighted information regarding an applicant's past, no risk assessment had been carried out prior to them being employed. DBS certificates from previous employers had been accepted by the provider, with no documented evidence that the disclosure service had been contacted for an update to check the applicant was not barred from working with vulnerable adults.

Medicines were not being handled correctly or safely. Some medicines had been missed when calls had not taken place as scheduled. There was no system in place to record medicines that staff administered and staff had undertaken giving medicines through a gastric tube without the provider realising this needed specialised training. The provider had no system in place to check staff were competent prior to handling medicines.

Staff training was not in line with the recommended training for staff working in adult social care. Although staff had been provided with training in safeguarding adults, and some had received training in emergency first aid and moving and handling in 2016, other expected training was out of date or had not been provided. For example, no staff had received fire safety training, food hygiene training or training in recording and reporting, or equality and diversity. No training had been provided in fluids and nutrition or person-centred care.

People said they were treated with care and kindness and could change how things were done during a visit if they wanted to. People were treated with respect and their dignity was upheld. This was confirmed by people we spoke with and relatives who provided feedback.

People's rights to make their own decisions were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People confirmed they were encouraged and supported to maintain and increase their independence.

People spoke to care staff if they had any concerns and felt they responded well to any concerns raised. People's right to confidentiality was protected and they received support that was individualised to their personal preferences and equality and diversity needs.

We found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff recruitment checks and documents were not being carried out as required, medicines handling was not always safe, staff training was not in line with requirements and the provider had not established an effective system that ensured their compliance with the fundamental standards. The fundamental standards are regulations 8 to 20A 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.

Full information about CQC’s regulatory response to the more serious concern found during this inspection, related to the breach of regulation 17 Good Governance, will be added to the report after any representations and appeals have been concluded.

We saw the agency had policies and procedures in place about involving people in their care. The policies recognised the diversity, values and human rights of people who use the service. We saw staff had received appropriate training to support them to effectively deliver these values.

The manager was responsive to requests for new services and changes to existing contracts. We heard the manager making arrangements to carry out a full assessment of need at the person's home before a service was provided.

We saw from records, people were asked to consent to care and support provided by the agency. Their agreement with the content of care plans was fully documented. We saw care plans were person centred and specifically designed to meet the needs of the individual.

Staff received appropriate training to ensure they could meet the needs of people using the service. They received an induction and core skills training before they started work. Staff told us they had received training in safeguarding adults and were knowledgeable about what constituted abuse and how to report it. The service had a quality assurance system in place, which regularly sought feedback from patients and other people about their experiences.