Background to this inspection
Updated
9 November 2023
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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by 2 inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At the time of our inspection there was a registered manager in post. The registered manager was also the provider of the service.
Notice of inspection
We gave the service a short period of notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 4 September 2023 and ended on 18 September 2023. We visited the location’s office on 4 September 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We gained feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 1 person who used the service about their experience of the care provided and gained feedback from 5 relatives. We spoke with 4 members of staff including the registered manager/provider, 1 senior carer and 2 care workers.
We reviewed a range of records. This included 8 people’s care records and 2 people’s medication records. We looked at 2 staff files in relation to recruitment and staff training and staff supervision. A variety of records were reviewed relating to the management of the service, including their medicines policy and audits and checks.
Updated
9 November 2023
About the service
Hands of Compassion is registered with the Care Quality Commission as a domiciliary care agency. It provides the regulated activity of personal care to adults living in their own homes, including older people and people with dementia. At the time of the inspection there were 8 people using the service.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
People’s experiences of the service were directly impacted by widespread and significant shortfalls in service delivery.
People’s levels of satisfaction with the service were mixed as they did not always receive consistent, timely care and support from familiar staff who understood their needs. Most people did not have a regular carer and some staff were task focused only providing 14 or 16 minutes of support during a 30 minute call. As a result only half of the people and relatives we spoke to said they would recommend the service to others.
Governance processes remained ineffective in identifying potential risks. Lessons had not been learned which had resulted in the same shortfalls found at the inspection in July 2022 being found at this inspection, a year later. These shortfalls were: Staff did not have guidance to ensure people with specific health needs such as catheters remained healthy. People were at risk of not receiving their medicines as prescribed as the provider was not following safe practices in administration. Staff recruitment processes were not robust due to gaps in employment having not been explored.
When shortfalls had been identified action had not been taken to make the necessary improvements to ensure quality of care. Surveys in May 2023 had identified that action needed to be taken to improve communication. However, there was no evidence of any steps that had been taken to address this shortfall.
Staff continued not to be adequately trained nor have all the skills, knowledge or competency required for their roles. Staff had not received practical training in how to move people safely despite the provider informing us in their action plan, after the last inspection, that this was being addressed. Staff relied on other untrained staff showing them how to move people and manage their medicines which had resulted in people using unsafe practices including the secondary dispensing of medicines. One staff member could not speak English to a sufficient level to discuss their training and another staff member who supported people was not listed as having had any training.
The provider had not met their responsibilities and legal requirements in regularly submitting reports in sufficient detail, as they were required to in their condition of registration. Nor had they notified us of their provider and location change of address.
People were usually supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Requires Improvement (published 15 February 2023) and there was a breach of regulation 18 (Staffing). The provider completed an action plan after the last inspection to show what they would do and by when to improve with regards to regulation 18 (staffing). At this inspection we found the provider had not done all the things that they said they had done. The provider remained in breach of regulation 18.
The provider has a condition on their registration due to a continuous breach of regulation 17 (Good governance). These conditions are the registered provider must send monthly reports to the Care Quality Commission. These reports must include the results of audits and actions taken for the management of medicines, care plans, risk assessments, missed calls and accidents and incidents, the oversight and implementation of mental capacity assessments, recruitment records and staff training and competence. The provider had not always sent these reports in sufficient detail, nor on a regular monthly basis.
Why we inspected
This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at the last inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hands of Compassion on our website at www.cqc.org.uk.
Enforcement
We have identified a continuous breach with regards to staff training and inadequate monitoring of service quality. In addition we have identified a new breach due to shortfalls in staff recruitment, the management of medicines and assessing risks.
We will continue to require the provider to send monthly reports as set out in the condition of their registration.
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.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This is the third time this service has been in rated ‘Inadequate’ and 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 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.