Background to this inspection
Updated
10 April 2015
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.
Our inspection took place on 30 January 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. Due to how small the service is the manager is often out of the office supporting staff or providing care and we needed to be sure that someone would be in.
The inspection was conducted by one inspector.
Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR and we took this into account when we made the judgements in this report. To plan our inspection we reviewed information we held about the service. This included notifications received from the provider about deaths, accidents/incidents, safeguarding alerts which they are required to send us by law and questionnaires we had sent out prior to the inspection.
We sent out 35 questionnaires to people and 14 were returned, 31 to care staff and six were returned, 35 to relatives and two were returned and 5 to other professionals and one returned. As a result of the information we received a number of safeguarding alerts were raised, leading to the local authority and the police conducting investigations. The local authority also suspended the service from receiving any new commissioned services while improvements were made to the service.
During our inspection we went to the provider’s main office location. While we were there we reviewed the care records of six people that used the service, reviewed the records for three members of staff and records related to the management of the service. We spoke with three members of staff, the manager and the provider who were present throughout the inspection. After the inspection visit we undertook telephone calls to three people who used the service and two relatives of two people who received services from the provider.
We also spoke with the local authority who confirmed the improvements they requested had been carried out and as a result the suspension against the service was removed.
Updated
10 April 2015
The inspection took place on the 30 January 2015 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because the service provides domiciliary care and we wanted to be sure that staff would be available.
Gateway HSC Dudley is registered to provide personal care services to 38 people living in their own homes. The registered manager had recently left the service and the new manager was in the process of applying to be registered. 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.
The people we spoke with told us they felt they received a safe service. People who completed the pre inspection questionnaires told us they did not feel safe, as staff did not always arrive on time and on some occasions staff did not arrive at all. We found that staff knew how to recognise abuse to keep people safe from harm and what action to take to keep people safe from harm.
We found that the deployment of staff was a concern. The provider told us this was an area they were already improving by employing more care staff and improving how care staff were deployed.
We found that care staff were supported by way of regular supervisions and staff meetings. The manager used these systems to ensure care staff were given clear guidance and expectations in how people were to be supported.
The care staff we spoke with told us they were able to attend a range of training course to improve their skills and knowledge. Records we saw confirmed this.
People also felt their medicines were not always administered safely. People told us that they did not always get their medicines when they expected. Records showed a number of gaps where medicines had potentially not been given.
We found that the provider did not ensure that staff had the appropriate skills and knowledge to meet the Mental Capacity Act 2005 legal requirements. We found that where people lacked capacity the appropriate assessments were not taking place.
The people and relatives we spoke with told us that care staff were caring. People who completed our pre inspection questionnaire gave a different experience of care staff. For example, care staff did not always respect their dignity by dressing them inappropriately.
We found that the provider had made improvements to how complaints were handled as a result of the concerns identified by way of the pre inspection questionnaires and the work carried to their improvement plan.
We found that the improvements required as a result of the support given from the local authority had been achieved and the suspension of the service had been lifted by the local authority. However the provider was still making improvements to how the service is delivered.
We found from the pre inspection questionnaires that the service was not well led. People we spoke with told us the service had improved and was much better managed with the appointment of the new manager.