Background to this inspection
Updated
30 March 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) 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 Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We brought this inspection forward following information that the registered manager was planning to leave. We required reassurances that the service would be managed effectively in their absence by the provider.
By day three of the inspection process, the registered manager, care co-ordinator and three other staff had left the service. We received four staff and two relative’s concerns. Therefore, we completed a further two inspection days to ensure people were safe.
Inspection team:
Inspection site visit started on 29 January 2019 and ended on 14 February 2019.
Days one and two of the inspection were completed by one inspector. Days three and four were completed by two inspectors. Although not present at the office, two experts by experience supported the inspection process by talking to people and their relatives over the telephone. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type:
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. By day three of the inspection, the registered manager had left the service. An interim manager had been introduced to manage the service in their absence.
Notice of inspection:
We gave the service 48 hours’ notice of the inspection visit because it is small and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in. We also needed to seek consent from people and their relatives to receive phone calls.
What we did:
During the inspection we reviewed;
• Information we had received about the service. This included details about incidents the provider must notify us about
• We used information the provider sent us in the Provider Information Return [PIR]. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make
• Completed CQC surveys from people who used the service
• Rotas and contingency plans
• Seven people’s care records
• Four people’s medicines records
• Seven staff files, including recruitment, training and supervision records
• Records of accidents, incidents and complaints
• Audits and quality assurance reports
We spoke with;
• Six people using the service
• Nine relatives
• Nine members of care staff
• The provider, business manager, company administrator, registered manager and interim manager
• The local authority
Updated
30 March 2019
About the service:
A Plus Care Ltd is a domiciliary care provider in the East Sussex town of Bexhill, which is situated close to the coast. On the first and second day of inspection, 38 older people received personal care support from the service. On days three and four of the inspection, 27 older people were receiving personal care. Some of these people were living with dementia.
Not everyone using A Plus Care Ltd received the regulated activity ‘Personal care’ that CQC inspects, which includes support with personal hygiene, eating and drinking. Where they do we also take into account any wider social care provided.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
People’s experience of using this service:
Before the inspection, the provider had limited involvement with the service and had allowed the registered manager to manage it independently. Therefore, when the registered manager left the service earlier than expected, the provider was not familiar with people, their needs, the regulations or their responsibilities. We found two incidents were not reported to the local authority or CQC within relevant timeframes. The provider required guidance in how to complete these referrals. Some areas for improvement identified at the previous inspection had not been actioned. There was a lack of oversight for concerns that had been raised previously with the registered manager. Supervisions, spot checks and team meetings had not been completed consistently. Although the registered manager acknowledged this was an area for improvement, they had not notified the provider. The current CQC rating was not displayed on the website as per regulation.
It was identified at the previous inspection that people without capacity to make decisions, did not have mental capacity assessments. We recommended that research was completed into responsibilities under the mental capacity act. The registered manager had undergone training in this area to develop their knowledge. However, they advised us they were still unclear of their responsibilities. They had not sought any further guidance on this.
Although people told us they felt safe, one person had not received their medicines consistently. Actions were not taken in a timely way by the provider or interim manager to ensure their wellbeing and notify relevant others.
People had assessments that detailed risks to their health and wellbeing and actions staff should take to reduce this. Staff knew people well and how to manage these risks. There were contingency plans for staff shortages or emergency situations that highlighted those people who would need priority support. Staff had a good understanding of potential signs of abuse and of who they would need to report any concerns to.
Despite frequent changes to staff and people’s care packages, the company administrator was managing the rotas well. People still received support from familiar staff. There had been no missed or late care calls since the registered manager had left. The provider and company administrator were speaking to people and staff to understand their care needs and ensure these were being met. The provider also advised they would not be taking on any other care packages until a robust management structure had been implemented.
People and their relatives told us that people’s health and nutritional needs were met. If they required support from staff with appointments, this was given. People had involvement from health and social care professionals frequently to improve their wellbeing. Where staff had identified concerns with the person’s environment, the registered manager had made referrals to professionals to gain equipment that would support them. Staff told us that training was good and gave them the skills they needed to meet people’s needs.
People and their relatives were consistent in their responses that staff were kind, caring and attentive to their needs. Many people considered staff to be extended family. They told us their independence, privacy and dignity was respected and promoted at all times. Staff had a good understanding of equality and diversity and supported people in their diverse beliefs and choices.
People and their relatives told us that the registered manager and staff were responsive to them and any changing needs. Pre-assessments completed before the person received support were then used to create a care plan about the person, their needs and preferences. People and their relatives told us any concerns they had were dealt with immediately by the registered manager. Staff had a good understanding of people’s communication needs.
Although staff had initially been concerned about the registered manager leaving, they told us that the provider, business director and company administrator had worked hard to ensure that changes did not impact on people. Staff had been able to talk to the provider directly with any concerns or worries about the future and been reassured. The provider advised that this inspection had identified their need for clear oversight of the service. They had already considered how this could be improved to prevent a similar situation occurring again. They had also arranged for support by the local authority to improve their knowledge of roles and responsibilities.
Rating at last inspection:
At their previous inspection, A Plus Care Ltd were rated Requires Improvement. (Report published 15 March 2018) At this inspection we found not all concerns raised at the previous inspection had been addressed. The registered manager left halfway through the inspection and the provider did not have clear oversight to manage the service. This is therefore the second time that A Plus Care Ltd have been rated Requires Improvement overall.
Why we inspected:
We brought this inspection forward following information that the registered manager was planning to leave. We required reassurances that the service would be managed effectively in their absence by the provider.
By day three of the inspection process, the registered manager, care co-ordinator and three other staff had left the service. We received four staff and two relative’s concerns. Therefore, we completed a further two inspection days to ensure people were safe.
Enforcement:
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.
We have served a warning notice for Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider must be compliant by June 2019. We will check the warning notice has been complied with at our next inspection.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.