Background to this inspection
Updated
1 April 2017
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, and to check that improvements to meet legal requirements planned by the provider after our inspection on 24 and 25 May 2016 and 1 and 3 June 2016 had been made. We looked at the overall quality of the service to provide a new rating for the service under the Care Act 2014; prior to this inspection, the rating for the service was Inadequate.
The inspection took place on 10, 11 and 12 January 2017 and was announced. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.
The inspection team consisted of two inspectors, with one present on all three days of the inspection and one on the 11 January. Before the inspection we reviewed the information the Care Quality Commission (CQC) held about the service. This included notifications of significant incidents reported to the CQC and the previous inspection report. We considered information of concern which local authorities had shared with us after the previous inspection. In addition to this we reviewed the provider’s action plans that had been submitted to CQC since the last inspection.
We were unable to speak with the one remaining service user but spoke with one relative of a person using the service. We also spoke with eight staff members. This included the managing director, the business development manager, the branch manager, one care coordinator, the human resources manager, the trainer and two care workers. We looked at five people’s care plans, which included the current person receiving support, three people who had recently been given notice in December 2016 and one person involved in the previous inspection. We looked at five staff recruitment files, staff training files and records related to the management of the service.
Following the inspection we contacted one health and social care professional who worked with the person using the service for their views and feedback. They told us that they were in the process of changing the care provider and sent confirmation that the person was no longer being supported by the provider on 23 January 2017.
Updated
1 April 2017
This inspection took place on 10, 11 and 12 January 2017 and was announced. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.
At the last inspection on 24 and 25 May 2016 and 1 and 3 June 2016 we found multiple breaches in relation to person-centred care, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaints, good governance, staffing, the employment of fit and proper persons and notification of incidents. The service was rated inadequate and placed into Special Measures as a result. We imposed a condition on the provider’s registration restricting them from providing personal care to any new Service User from First Choice Home Care and Employment Services Limited Hackney without the prior written agreement of the Care Quality Commission. The provider sent in an action plan to tell us what they were going to do to make improvements. However during this inspection we found that insufficient improvements had been made.
First Choice Home Care and Employment Services Limited Hackney is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our previous inspection the service was providing support to 429 people in the London Boroughs of Hackney and Camden. The majority of the people using the service were either funded by the local authority or the NHS. After the inspection the local authorities arranged for people to be transferred to alternative care providers and at the time of this inspection, there was only one person being supported with personal care by the service.
There was a manager in post at the time of our inspection who had worked for the provider since October 2016 and had applied to be a registered manager. The previous branch manager had left after the last inspection and the last registered manager in place left in April 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 who lived with specific health conditions had not had the risks associated with these conditions properly assessed and care plans were not developed from these to ensure their safety and welfare. Risk assessments were not detailed and did not provide staff with information or guidance on how to minimise the risk.
Appropriate policies and procedures were not in place to ensure that people received their medicines safely and effectively. People’s medicines were not being recorded correctly or checked. There was also no evidence that staff had received regular competency training to ensure that they were able to prompt and administer medicines safely.
Safeguarding incidents had started to be logged however people were still not always protected from the risk of potential abuse because the provider did not always act appropriately to safeguarding concerns or follow them up to ensure people’s safety.
Staff files had been checked and a system was in place for Disclosure and Barring Services (DBS) checks. However robust recruitment procedures were still not in place to minimise the risk of unsuitable people being employed.
Staff still did not have a clear understanding of the principles of the Mental Capacity Act 2005 (MCA). Where family members had signed to consent to the care and support of their family member, the provider was unable to demonstrate that the relative had the legal authority to do so and was therefore not working in line with the MCA.
The action plan that had been submitted told us that staff had received refresher training in a number of areas since the last inspection, however we found that it had not been done. We saw that staff supervisions had started to be carried out however they did not always have an accurate record of what had been discussed.
Relatives commented positively about their regular care workers’ caring attitude and said they had built up a positive relationship. There was evidence that people’s privacy and dignity was respected. However, training in this area that we had been told had been completed had not been done.
We saw evidence of improved personalisation in people’s care plans, however they still lacked detailed information and were not specific to people’s needs which put them at risk of receiving unsafe or inappropriate care. We were not assured they reflected people’s wishes and how they wanted to be cared for.
Records showed that people were not always involved in making decisions about their care and the support they received, when they were able to do so.
Systems to record and investigate complaints, incidents, accidents and serious events had been introduced however such events were not always recorded, followed up or resolved before being signed off by managers. Information was not used as an opportunity to learn and improve the service.
Quality monitoring systems that had been introduced did not identify or address shortfalls in the operation of the service. Shortfalls identified at our last inspection had not been satisfactorily addressed by the management team.
The action plan that was submitted to us by the provider had not been followed through effectively to improve the service. It was not clear if all staff had access to the plan to work towards achieving the outcomes highlighted.
The provider continued to not meet their legal obligations to notify the CQC about serious incidents and allegations of abuse.
We found continued breaches of regulations in relation to consent, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing, fit and proper persons employed and notifiable incidents. 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.
The overall rating for this service is 'Inadequate' and the service therefore remains in 'special measures'.
The service was kept under review and we have found that not enough improvement was made. Therefore we are now considering what action we will take in line with our enforcement procedures to begin the process of preventing the provider from operating this service.
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 it will no longer be in Special Measures.