13 January 2015
During a routine inspection
We undertook an announced inspection of Southwest Home Care on Tuesday 13 January 2015. We told the provider on Monday 12 January 2015 that we would be coming to make sure that staff would be available in the office. When Southwest Home Care was last inspected in August 2014 there were no breaches of the legal requirements identified.
Southwest Home Care provides personal care and support to people in their own home. At the time of our inspection the service provided care to 11 people.
A registered manager was in post at the time of 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.
People and their relatives did not feel safe with the care provided by the service. We received positive comments about staff, however people said they could not rely on the service to deliver care at the time they needed it.
The provider had a safeguarding adults policy for staff that gave guidance on the identification and reporting of suspected abuse. However, staff were unaware of how to report suspected abuse or concerns for people’s welfare externally.
People and their relatives said the staffing levels were insufficient at the service and had resulted in a large amount of missed calls and late care appointments that meant the service had not met their assessed needs. Staff told us the current staffing arrangements could not safely meet people’s needs. The registered manager explained the service was currently recruiting, however they told us they had not enlisted the use of agency staff to ensure people’s needs were met in the interim. The provider had not consistently completed safe recruitment procedures to ensure staff were suitable to work.
The provider had not undertaken an assessment of people’s needs and planned people’s care accordingly. Where risks had been identified by another agency or the service itself, no planning had been undertaken or no record made of the risk management to be undertaken by staff to keep the person safe.
Most people and their relatives told us they managed their own medicines. The staff training record did not indicate that appropriate medicines training had been undertaken and staff competency with medicines was not assessed by the provider to ensure people’s safety.
People and their relatives gave some positive feedback about the staff that provided care, however staff had not received training to ensure they could meet the needs of people who used the service and staff training records were not accurate or fit for purpose.
Staff could not demonstrate they understood their obligations under the Mental Capacity Act 2005 and how it had an impact on their work. They were unaware of how they would act in accordance with legal requirements when people lacked mental capacity to make that decision themselves. The registered manager told us that no MCA training was provided for staff.
People and their relatives told us they were not involved in the planning of their care and support. They said they did not feel the service had listened to them about matters important to them. People told us they did not always feel respected by the service and that on occasions, their privacy and dignity was not taken into account during care planning.
People and their relatives told us the care provided did not meet the needs of the person who received it. We saw within people’s care records there was no recorded information about how they liked to be supported, what was important to them and how to support them. There were no effective systems to monitor the health and well-being of people who used the service and the provider had not maintained appropriate records.
Staff told us they did not always feel supported by the provider and registered manager and people who used the service told us they had not met the provider or registered manager. There were no effective systems in place to obtain the views of people who used the service and their relatives. People told us they were unaware of the complaints process within the service. The provider had failed to bring the complaints procedure to the attention of people and their relatives.
The provider had failed to notify the Commission, as required, of a safeguarding adults notification relating to a person who used the service.
The provider had a staff appraisal and supervision process and staff told us they felt supported. An induction process was undertaken by new staff to ensure they had sufficient knowledge and skills to provide care to people.
We found multiple beaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in multiple regulations. In addition, a breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. You can see what action we told the provider to take at the back of the full version of this report.