Santos Care Limited

Updated 20 December 2023

The inspection

We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating. 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 team consisted of 3 inspectors and 1 expert by experience who made calls to people and relatives remotely. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

The inspection was announced. We gave the service 24 hours’ 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.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with 3 people who used the service and 7 relatives. We also spoke with 4 care staff, 2 office staff and the registered manager who is also the nominated individual. A nominated individual is a person who supervises the management of a regulated activity across an organisation. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We contacted 2 integrated care boards (ICB’S) to gain feedback on the service. We reviewed 4 care plans and a selection of call records, daily notes, medicine records, risk assessments, audits and policies and procedures. We also used technology such as electronic file sharing to enable us to review documentation sent to us by the provider following the site visit.

Updated 20 December 2023

About the service

Santos Care Limited is a small domiciliary care provider. At the time of our inspection there were 15 people using the service.

People’s experience of the service and what we found:

Care plans and risk assessments lacked detail, peoples wishes and preferences were not always recorded to ensure care was provided in a way they chose or wished. Some risk assessments were generic and not person centred. Risk assessments did not always contain information on how risks were managed or mitigated.

Health management plans were generic and contained details which could mislead staff in relation to what support fell within or outside of their competencies.

Care plans held conflicting information as to the care that was to be provided. What was written in the care plan did not always reflect the actual care taking place.

The provider had ineffective systems and processes in place to ensure full and effective oversight of the service and the quality of care provided.

People and relatives were not confident that staff were trained and competent in completing tasks as part of their or their relatives’ care.

Best interest meeting records did not capture full details of the decision to be made or why it was needed, also records did not always demonstrate all the relevant options had been explored.

Where people took medication, it was not clear who was responsible for the management and administration of medication.

People consistently received late calls.

Rating at last inspection and update

The last rating for this service was Requires Improvement (Published 26 April 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At our last inspection we recommended improvements to be made in regulation 9 (Person centred care, regulation 11 (Consent), regulation 12 (Safe care and treatment), regulation 17 (good governance), regulation 18 (Staffing). A warning notice was issued for the breach of regulation 12 (Safe care and treatment and regulation 17 (good governance). At this inspection we found the service remained in breach of regulations.

Why we inspected

When we last inspected Santos Care Limited on 7 March 2023 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

You can see what action we have asked the provider to take at the end of this full report. Please see the Safe, Effective, Responsive and Well led sections of this full report. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Santos Care Limited on our website at www.cqc.org.uk.

Enforcement [and Recommendations]

We have identified continued breaches in relation to Regulation 9 (Person centred care), Regulation 11 (Consent), Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

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 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 time frame 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 the 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.