Background to this inspection
Updated
14 September 2016
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.
This inspection took place on 15, 18 and 19 July 2016 and was unannounced. The inspection was carried out by two inspectors and an enforcement inspector. An inspector made calls to people, their relatives and staff on the second day.
Before the inspection, we reviewed the information available to us about the service, such as the notifications that they had sent us. A notification is information about important events which the provider is required to send us by law. We also reviewed the reports from local authority monitoring visits.
During the inspection we spoke with nine people who used the service, seven members of staff and the regional support manager. We looked at the care plans for 20 people, which included risk assessments, guidelines, healthcare information and records relating to medicines. We looked at eight staff files including recruitment information and training records. We also looked at quality audits, satisfaction surveys, minutes of meetings and complaints received by the service. We reviewed information on how the quality of the service was monitored and managed.
Updated
14 September 2016
We carried out an unannounced focused inspection on 15, 18 and 19 July 2016 in response to an on-going safeguarding investigation into the death of a person using the service. At the time of the inspection, the service provided care and support for 78 people living in their own homes.
The service did not have a registered manager and there was no manager in post at the time of our 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.
During the inspection we identified significant concerns in relation to the safety of people using the service and the overall management and leadership in place. As a result we served a notice to restrict any further admissions to the service on 22 July 2016. The provider had informed us on 19 July 2016 that they were insolvent and due to appoint liquidators the following week, which meant that people had to be found alternative care providers by the local authority. The provider subsequently applied to cancel their registration of the service on 22 July 2016 which meant that no further care or support would be provided from this location.
People were exposed to a risk of avoidable harm as a result of inadequate management and a consistent failure to monitor their care and support needs. People did not receive their visits on time and these were frequently reported as having been missed or late. Despite the demonstrable impact upon people, the service had not developed effective systems to monitor this or identify ways in which it could be improved.
People’s medicines were not managed safely and they did not always receive them on time. Staff were trained to administer medicines, but people’s care plans did not contain sufficient information to support them to understand people’s needs. The medicine administration records kept to account for people’s medicines contained gaps, errors and were not audited efficiently to identify ways to improve upon this.
The service did not have a registered manager and there was no consistent, stable management or leadership in place. People and staff did not feel that they were listened to and did not have confidence in the management of the service to improve. The quality monitoring systems in place were inadequate for identifying improvements that needed to be made, and the lack of managerial oversight in the service meant that changes were not made as required. The service did not follow their own policies in relation to people’s care and support, and people were receiving inadequate care as a result.
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.