Archived: Wii Care Limited

Wii Care Limited was registered to provide personal care services to people living in their own homes, mainly in the Medway area. There was an office base in Rochester in Kent. When we last inspected the service there were 82 people receiving a service. At this inspection there were five people receiving a service. Two people lived with relatives and three others lived alone in the community.

The service had a registered manager. 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 registered manager was also the registered provider of the service.

At our previous inspection on 16 and 19 January 2017 we found breaches of Regulations 9, 10, 11, 12, 16, 17, 18, 19 and 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. The provider had failed to provide care and support which met people's needs and preferences. Medicines had not been properly managed. Risks to people had not been adequately assessed. The provider had failed to carry out adequate employment checks. Consent to provide care and treatment had not been undertaken with the relevant persons. Complaints had not been dealt with effectively. Systems to monitor quality and safety were not always operated effectively and records were not always accurate and complete. Sufficient numbers of staff were not deployed to be able to provide the assessed personal care needs of people using the service. The provider had failed to provide care and treatment to meet people’s needs. People had not always been treated with dignity and respect. The provider had failed to display their rating and had failed to notify CQC of events and incidents. We asked the provider to take action to meet Regulations 11, 19 and 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. We took action against the provider in relation to Regulations 9, 12, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We received an action plan on 30 March 2017 which stated that the provider had met Regulations 11 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of The Care Quality Commission (Registration) Regulations 2009 by 01 March 2017. They planned to meet Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 31 May 2017. At this inspection we found the provider had not implemented all of the improvements they had identified in their action plan.

Medicines records, risk assessments and administration required improvement. When medicines had special instructions for administration these were not included in the information for staff.

Risk assessments were in place to help to keep people safe. However, the risks identified and the control measures recorded to manage the risks were basic and generalised. The risk assessments had not been personalised and did not mitigate all the risks associated with people’s health and care.

The provider and registered manager had made improvements to the processes in place to monitor the quality and safety of the service provided. However, further improvements were required to ensure the provider and registered manager continued to improve the service. None of the issues we found during our inspection had been picked up by the provider and registered manager. Records, documents and policies were not all accurate.

The provider and registered manager had carried out sufficient checks on new staff before they started employment to ensure they were suitable to work with vulnerable people. However, two out of four staff files contained missing and inaccurate information which put the quality of the checks carried out in doubt.

The provider had safeguarding procedures in place for staff to follow to keep people safe. Staff knew what signs to look out for that might suggest people were at risk of harm. Staff were able to describe what they would do if they had concerns and who they would report these to. The provider and registered manager did not have a copy of the local authorities safeguarding protocols, policies and procedures. We made a recommendation about this.

People’s capacity to make their own choices and decisions had been considered following the principles of the Mental Capacity Act 2005. However capacity assessments conflicted with information about the person which had been detailed in their care plan. Capacity assessments were not decision specific. We made a recommendation about this.

People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and reviewed to make sure people continued to have the support they needed. People’s care plans detailed what staff needed to do for a person. The care plans did not always include information about their life history and were not always person centred. We made a recommendation about this.

Staff had received training relevant to their roles. One staff member had not attended training relating to all of the assessed needs of a person they worked with on a regular basis. We made a recommendation about this.

There were suitable numbers of staff deployed on shift to meet people’s needs. Staff had adequate time on their schedules to provide people their assessed care needs and had time to travel to the next person without rushing or cutting people’s care short.

Staff received support through one to one supervision meetings. Staff competency to perform their role was checked by the training manager to ensure training delivered had been put into practice.

People told us they thought the staff were caring and they enjoyed their visits. People were given the time and care they needed to be able to maintain their independence and dignity.

Staff supported people whilst maintaining their privacy. Confidential records were securely stored.

Complaints had been adequately recorded, investigated and managed by the provider and registered manager. A complaints procedure was in place detailing the process of how to make a complaint and how it would be handled and responded to.

People’s views and experiences were sought through review meetings and through surveys.

People were supported to be as independent as possible.

Staff felt well supported by the provider and registered manager. They felt they could raise concerns and they would be listened to. They were able to freely access the provider and registered manager when they needed to and we saw that staff visited the office to do this.

Relatives told us that staff were kind, caring and communicated well with them.

People and their relatives had been involved with planning their own care. Staff treated people with dignity and respect.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Wii Care Limited was registered to provide personal care services to people living in their own homes, mainly in the Medway, Dartford, Swanley and Gravesend areas. There was an office base in Rochester in Kent. When we last inspected the service there were 158 people receiving a service. At this inspection there were 82 people receiving a service. Some people lived with relatives and some lived alone in the community. Some people received their care in bed.

The service had a registered manager. 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 registered manager was also the registered provider of the service.

At our previous inspection on 12 and 13 September 2016, we found breaches of Regulations 9, 12, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to provide care and support which met people's needs and preferences. Medicines had not been properly managed. Risks to people had not been adequately assessed. Complaints had not been dealt with effectively. Systems to monitor quality and safety were not always operated effectively and records were not always accurate and complete. Sufficient numbers of staff were not employed to be able to provide the assessed personal care needs of people using the service. We asked the provider to take action to meet Regulations 9, 12 and 16. We took action against the provider and told them to meet regulation 17 and 18 by 03 January 2017. At this inspection we found that the necessary improvements had not been made.

We received an action plan on 02 December 2016 which stated that the provider planned to meet Regulation 9, 12 and 16 by the 31 December 2016. At this inspection we found the provider had not implemented the improvements they had identified on their action plan.

The provider had reduced the numbers of people they were supporting since the last inspection which had relieved some of the pressure in some areas. However, we found that staff were continuing to have too many care visits to make as there were still insufficient numbers of staff available to deliver the amount of care visits required. Rotas were inaccurate, showing individual staff working in more than one person’s home at the same time. We were told, and we saw evidence to suggest that staff were regularly delivering care on their own to people who had been assessed as requiring two members of staff to support them.

Although there had been an improvement in the medicines administration records, we found that records were still not accurate, leading to unsafe practice. Many items were administered and not recorded and sufficient guidance was not always in place for ‘as and when necessary’ (PRN) medicines.

Accidents and incidents had not been reported in many cases and those that had been reported had not been documented to ensure an accurate record was kept to keep people safe, to learn from mistakes and to check trends.

Individual risks had not been identified to keep people safe from harm. This meant that control measures to reduce the risks to people had not been recorded for staff to follow. Environmental and general risks that were relevant to everyone had been identified.

The provider had not carried out sufficient checks on new staff before they started employment to ensure they were suitable to work with vulnerable people. We did not find evidence that new staff had worked with the correct supervision while waiting for recruitment checks to be finalised.

The provider had safeguarding procedures in place for staff to follow to keep people safe. Staff knew what signs to look out for that might suggest people were at risk of harm. Staff were able to describe what they would do if they had concerns and who they would report these to.

People’s capacity to make their own choices and decisions had not been considered following the principles of the Mental Capacity Act 2005. Family members were often asked to sign consent forms without an assessment being undertaken to determine the person’s capacity first. There was no evidence that decisions had been made in the person’s best interests.

Although staff supported some people at lunchtime by making and serving their meals, we found that lunchtime visits were very often far shorter than the time that had been assessed to carry out this task. There were no specific risk assessments or care plans for individual people who may be at risk of malnutrition and required staff support at mealtimes.

There was insufficient recording of people’s health needs. Where people had a clear health issue that needed the attention of a health care professional, communication and documentation was poor at each care visit and between care staff and office staff. This led to uncertainty whether people had actually been referred for the appropriate health care.

Staff received support through one to one supervision meetings although this was not consistent for all staff. There was no clear line management structure to enable staff to have a named line manager to ensure clear lines of responsibility and accountability.

The provider employed an in house trainer and staff did receive training in the areas relevant to their role. However, we found that staff attended as many as 15 or 16 training courses in one day. We made a recommendation about this.

People, their family members and staff told us that the many of the newer staff in particular did not seem to have the knowledge they required to carry out their role.

People told us they thought the staff were generally caring and they enjoyed their visits. However, the evidence we found was that visits were often cut short or delivered by one member of staff when two were required. People were therefore not given the time and care needed to be able to maintain their independence and dignity.

Staff supported people whilst maintaining their privacy. Confidential records were securely stored.

Complaints were poorly managed by staff and the provider. A complaints procedure was in place detailing the process of how to make a complaint and how it would be handled and responded to. However, the provider did not follow their own procedure. We found many complaints made and not responded to and many that had not been recorded.

People had an assessment before support commenced and care plans were developed to document the support people required. However, although people stated the times they wanted their support during their assessment, these times were often not adhered to, instead people received their support at times to suit the rota. Care plans were not always reviewed to update information where people needs had changed which meant that people were receiving different support to that described in their care plan.

The provider had not made any improvements to the processes in place to monitor the quality and safety of the service provided. None of the issues we found during our inspection had been picked up by the provider. The provider had undertaken quality audits in some areas but these had not been robust enough to capture the action required to improve the service. Lessons had not been learnt from complaints or accidents and incidents in order to prevent further concerns and to strive for improvement.

Accurate records were not kept either by care staff, office staff or the provider to ensure good communication and the safety of people supported in their own homes.

We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

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.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We carried out an announced comprehensive inspection of this service on 16 January 2015. After that inspection we received concerns in relation to; staff not getting paid on time, staff not turning up, staff turning up too late or too early, people consistently not receiving the amount of support time allocated to them and poor moving and handling techniques. We reported these concerns to the local authority. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wii Care Limited on our website at www.cqc.org.uk

At the time of the previous inspection the service delivered personal care to 20 people.

Wii Care Limited was registered to provide personal care services to people living in their own homes, mainly in the Medway, Dartford, Swanley and Gravesend areas. There was an office base in Rochester in Kent. At the time of our inspection there were 158 people receiving a service.

There was a registered manager based at the service who was also the registered provider. 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.

All the people we spoke with were not happy with the service provided. They said staff often arrived either too late or too early which meant they were sometimes turned away. Often staff did not turn up at all and when people rang the office to report this they did not get the help they needed. The staff did not spend the full amount of time people were assessed as needing. Most of the people we spoke with told us they did not have the same staff each time so their care was not consistent.

The registered provider did not have sufficient staff to provide the personal care that people were assessed as needing. The records we looked at, including staff rotas and timesheets showed that staff often had more visits than they had time to do in the time allocated. Rotas were inaccurate. Frequently more than one person had been allocated the same support time with the same staff member. Most of the time staff had two or three visits to make at 07:30 or 08:00. This meant that they were running late for all of their care visits from the very beginning of the day.

Staff did not have any break times allocated into their rota for the day. Travelling time between people’s homes was not allocated on the rota. This meant that staff did not have an opportunity to take a break through the day as they were always catching up on time.

People were placed in a vulnerable situation by not receiving the care and support they had been assessed as needing. Staff rotas showed that staff often started their first care and support visit far earlier than had been planned on their rota. People had not received their care and support at the times allocated or agreed with them which meant their needs and preferences were not met.

Individual risks were not identified and assessed to make sure staff provided the most appropriate and safe care to people in their homes. Environmental risks inside and outside the property had been suitably assessed to help to keep staff safe when visiting people’s home’s.

Recruitment policies were in place that had been followed. Safe recruitment practices included

background and criminal records checks prior to staff starting work. Staff were not recruited until they had been through a selection process that ensured they were suitable to work with people.

The registered provider did not have measures in place to ensure the safe administration of medicines to people in their homes. Guidance was not available to staff when administering people’s prescribed medicines. Information describing the potential side effects of people’s medicines was not evident. Instructions when to give ‘as and when necessary’ (PRN) medicines were not in place to give advice and guidance to staff when administering these medicines.

There was no clear and robust system in place to deal with complaints. Some people told us they had made complaints and because they had not had a satisfactory response they didn’t raise other complaints. Some people were responded to and others were not. There was no quality assurance by the registered provider to make sure complaints were logged and responded to appropriately. No systems were in place to check trends or to be able to learn from complaints made in order to improve the service.

Staff were dissatisfied as their monthly pay had been late on a number of occasions.

Monitoring and auditing systems were not in place to check the quality and safety of the service provided. The registered provider had introduced two quality assurance systems to check care plans and to check medicines administration. However these had not been effective as no issues had been picked up and no action planning was in place to rectify problems found.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

We found that there was mainly a robust recruitment process in place that helped to make sure that only people who were deemed as suitable were employed to care for people who used the service.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff training records showed that staff kept up to date with all required training; and staff told us that about the training they had undertaken.