Archived: Laurel Bank Support at Home

Laurel Bank Support at Home is a domiciliary care service offering care to people in their own homes. The service covers areas in both Tameside and Stockport and was offering support to approximately 104 service users at the time of the inspection.

There was no registered manager at the time of the inspection. There was a manager in post on the first day of the inspection; however they had left the service by the second day. 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.

Staff had undertaken mandatory training; however they were unable to demonstrate their knowledge and understanding of subjects including safeguarding vulnerable people from harm.

Risk assessments were not always in place and where they were they did not reflect the specific risk or the measures needed to minimise the risk.

Staff recruitment processes were not always in line with the organisations policy.

Medicines were not managed safely and there were poor standards of care for specific conditions including diabetes.

Staff were not well trained and supported to carry out their roles effectively.

The service was not working within the Mental Capacity Act 2005, and was not gaining consent from people for the care they received.

Whilst staff were kind and committed, they lacked understanding in relation to treating people with dignity and respect. Staff also confirmed they sometimes overstepped the boundaries of a professional carer.

Care plans were not person-centred and did not reflect the needs of people who used the service. There was little evidence that care plans were reviewed.

There was no leadership in the service, which had been without a registered manager for a period of 480 days. There was no oversight or monitoring of the quality and safety of the service by the senior manager or registered provider.

The service was found to be in breach of seven regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms 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.

Following that inspection visit the provider sent a report which told us what action they would take to meet the regulation and the date the action would be completed by.

From reviewing our records and evidence received from the service we can see that actions were taken to ensure the registered person notified us if a registered person ceased to carry on or manage the regulated activity.

We found that the provider had made improvements to how they recruited staff; this meant that the provider performed the appropriate checks before staff began work.

We saw that people's care records were accurate and staff were aware of people's individual needs. The provider had a plan for managing emergencies and sought help from relevant professionals when needed.

We saw that the provider did not have an effective system for recruiting staff. They did not assess the risks of employing people with convictions or with relevant health problems. They did not collect adequate information about people's work history, to enable them to make an informed decision about people's suitability to work.

The provider now had a system for monitoring visits, to ensure they had enough staff to meet people's needs and keep people safe. Staff praised the support provided by the management. People who used the service praised the competency and quality of the staff. We saw that the provider now had a system for assessing and monitoring the quality of service provision, which ensured that they collected information about and responded to incidents, complaints and people's views about the service.

We saw that the provider had made improvements to people's care records and records relating to the management of the service, such as incident records.

We saw recent complaints to the provider from people who used the service. The people were dissatisfied with care workers showing up at the wrong times or not at all. One person said this was a shame as they really liked the carers.

We observed the provision of care in the homes of two people. We saw that people looked comfortable. We saw that they engaged positively with their care workers. We found that people's care plans did not always reflect updated information regarding their needs. We saw that staff relied on daily records to share information about people's care. We found that staff did not always read this information.

We found that staff did not receive appropriate training, supervision, or support. We found that there were not always suitably qualified staff available to meet people's needs. We found that the provider did not have an effective system in place to monitor quality.