5 December 2018
During a routine inspection
This service was inspected in January 2013 but did not have people using the service, and remained dormant until October 2018.
At this inspection in December 2018 we found breaches of fundamental standards and regulations. The provider had not acted to make sure medicines were managed safely. We found the provider had not taken action to support people where allegations of abuse were raised and to reduce the risk of similar future incidents. Recruitment practices placed people’s safety at risk. The provider had not completed a risk assessment for every person when they started using the service. Staff did not always attend people’s care calls as required by them.
Staff did not receive appropriate training and support to complete their roles safely. The provider did not ensure the safe assessment and care planning of all people’s individual needs.
People and their relatives told us their privacy was not respected and staff had not acted in accordance with people’s wishes. The provider had not followed their complaints procedure.
The provider did not ensure appropriate systems and processes were in place for the management of risk, safe recruitment of staff, safe management of medicines, staff training and overall governance of the service. The provider lacked oversight, understanding and management of the service and left the people at risk of harm. The provider had not ensured they monitored and analysed early or late visits so patterns could be identified and improvement made. The provider had failed to notify CQC of notifiable events.
There was no system to manage accidents and incidents to reduce the likelihood of them happening again. The provider had not completed health action plans for people who required. The provider did not have systems and procedures to ensure an effective joint-working with other services.
People and their relatives told us their privacy was not respected and staff had not acted in accordance with people’s wishes. The provider had not given consideration for equality and diversity. Staff supported people to eat and drink enough to meet their needs. However, people did not have care plans about their diet and nutritional needs and this required improvement. The provider had involved people and their relatives, where appropriate, in the review of their care.
People gave us a mixed feedback about how their complaints were managed. The provider had a policy and procedures in place to support people with end of life care in line with their wishes.
There were no staff meetings held to share learning, and good practice so staff understood what was expected of them at all levels. The provider had not maintained any records to show that they worked with health and social care professionals and commissioners. Staff described the management of the service positively. The provider had a policy and procedures to work with commissioners, health and care professionals. However, the feedback from commissioners was not positive.
People were protected from the risk of infection. The service had a registered manager in post. 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.
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 concerns found during inspections is added to reports after any representations and appeals have been concluded.