Archived: De Vere Care - Southend on Sea

Our last inspection of this service in May 2018 highlighted several concerns and we imposed conditions on the service that they could not take on new care support packages without prior application to the Care Quality Commission. The service was rated Inadequate overall and placed in special measures. The provider wrote to us to inform us of the actions they had taken since to improve the service. Significant improvements had been made since our last inspection, such as ensuring staff attend calls on time, improved recruitment processes and better managerial and provider oversight to ensure good care delivery and strong quality processes.

The service is required to have 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. At the time of our inspection the manager was going through their registration process with the commission.

Staff delivered support effectively and care was provided in a way that promoted people’s independence and wellbeing, whilst people’s safety was ensured. Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people’s individual needs to be met in line with their assessed needs. Trained staff dispensed medications and monitored people’s health satisfactorily.

Staff understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers, community mental health nurses and GPs to implement care and support plans.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person-centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. People were supported to identify their own interests and pursue them with the assistance of staff. Person centred social activities took place within the service. A complaints procedure was in place and had been implemented appropriately by the manager.

Systems were in place to make sure that people’s views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. The service was assisted to run effectively using quality monitoring audits carried out by the senior management and the manager, which identified any improvements needed and actions were taken.

De Vere Care – Southend is a domiciliary care agency. This service provides personal care to people living in their own houses and flats. It provides a service to adults who may be living with dementia, a physical disability and/or mental health conditions.

At our previous inspection on 20 November 2017, we rated the service Good overall but needing improvement in Safe.

The registered manager left the service in November 2017 and although there was a manager in post they had not applied 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.

At this inspection, we identified that the service failed to provide all the people it served with safe care and treatment. Staff have been continually paid late or incorrectly which had resulted in care workers and office staff resigning. People’s calls had been late, missed or shortened due to a lack of care workers. There had been a 39% reduction in staff since December 2017 and existing staff had been attempting to cover all of the necessary calls. Because of this people had missed their meals and medication placing them at risk of harm.

Recruitment practices required improvement to ensure that care workers were safe to work with vulnerable people. Although people had been protected against the risk of infection improvements were needed because requests for personal protective equipment, such as gloves, had been delayed.

Although care workers told us they felt supported and well trained, improvements were needed because they had not received supervision as often as required within the service’s own policy. Training records showed that care workers’ training had not always been updated regularly.

Where people had regular care workers, they were well supported to eat and drink and they felt they were kind, caring and compassionate and knew them well. However, some people had either missed their meals, or had them very late in the day due to missed and late calls. This placed them at risk of dehydration and/or poor nutritional intake. The recent staffing problems also meant that people without regular care workers often felt rushed despite their care workers kindness.

The manager had carried out monthly audits of systems and practices; however, improvements were needed as the action plans they devised did not include clear timescales for action to be taken.

The provider had not taken action to improve the situation therefore their lack of oversight, understanding and management of the service has had an impact on a large number of vulnerable people. The provider failed to identify and address concerns and breaches of regulatory requirements. This has led to risks to the quality of care and to people’s health and wellbeing.

There were policies and procedures in place for safeguarding people. Care workers were trained and knew how to apply the training, and safeguarding matters had been dealt with appropriately. Although people told us they felt safe with their care workers, the impact of missed and late calls had made some people feel unsafe.

Care workers had received health and safety training and had an understanding of how to manage risk. People’s care plans contained risk assessments and management plans. People’s needs had been fully assessed and their care plans reflected this. The service had regularly reviewed and updated care plans and risk assessments to ensure they continued to meet people’s needs.

People received appropriate healthcare support when needed. The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA) to ensure that people had as much choice and control over their lives as possible. Care workers had been trained and had an understanding of how to support people to make decisions.

People had been fully involved in the assessment and care planning process and their care plans met their needs. Complaints had been dealt with appropriately and were discussed at team meetings to enable lessons to be learnt.

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.”

The Commission took urgent action after the first day of inspection to ensure people remained safe, and were not placed at continued risk. We served an urgent notice of decision to impose a condition that the provider must not provide personal care to any new service user from De Vere Care - Southend without the prior written agreement of the Care Quality Commission.

You can see what action we told the provider to take at the back of the full version of the report.

De Vere Care – Southend is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults.

There was a registered manager in post at the start of this inspection; however, they left the service on 22 November 2017. The service is currently being managed by the deputy 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.

We found some minor concerns in relation to medication management and the recording of some people’s medicines. We have made a recommendation about the management of medicines.

People were protected from the risk of harm. Care workers knew how to protect people and the service had systems and processes in place including a robust recruitment practice to ensure people were cared for by appropriate staff. Care workers had been trained and were well supported to do their work.

People received personalised care that was responsive to their needs. Their needs had been holistically assessed and their care plans had been regularly reviewed to meet any changing needs. They and their families had been fully involved in the assessment and care planning process. The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA). People were supported to have as much choice and control over their lives as possible and their independence was encouraged.

Care workers cared for people in a kind, caring compassionate way. People told us they were respectful and treated them with dignity. People said their regular care workers knew them well and supported them with food, drink and their healthcare. They told us that substitute care workers during weekends or when their regular care worker was not at work, were not as effective but that they ‘did their best’.

People’s concerns and complaints were listened to, acted upon and resolved. The service learnt from complaints and made changes to ensure that people received an improved service. Confidential information was stored safely in line with data security standards. There was a good quality assurance system in place to monitor the service and to drive improvements.

Further information is in the detailed findings below.

De Vere Care – Southend on Sea is registered to provide personal care and support to adults in their own homes in the Southend on Sea area.

There was a registered manager in post. 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.

At our last inspection in December 2014 we had concerns about medicines management. At this inspection improvements had been made and people now received their medication as prescribed. People’s medication was now managed safely.

Staff had a good understanding of how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them with the process. Risks to people’s health and safety had been assessed and the service had up to date care plans and risk assessments in place to ensure people were cared for safely.

People received their care and support in a way that ensured their safety and welfare. Staff had been safely recruited in sufficient numbers. They had a good induction, regular supervision and training and felt well supported by the registered manager.

The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and were working within the principals of the MCA.

People were supported to have sufficient food and drink to meet their needs. People’s care needs had been assessed and catered for. The care plans gave staff enough information about how to meet people’s individual needs and how to care for them safely. People were supported with their healthcare needs; the service sought advice and guidance from healthcare professionals when needed. Staff treated people with kindness and compassion and maintained their privacy and dignity at all times.

People knew how to raise a concern or complaint and were confident that their concerns would be listened to and acted upon.

There was an effective system in place to assess and monitor the quality of the service and to drive improvements.

On the day of our inspection the manager told us that there were 79 people using the service. We spoke with 14 people who used the service, three relatives of people who used the service, 10 members of staff, the training officer, the human resources manager and the interim manager of the service. We examined records that related to care planning, medication, recruitment and quality assurance.

We thought about what we found and asked the questions that we always ask; Is the service safe, effective, caring, responsive and well-led?

This is a summary of what we found:

Is the service safe?

All staff had received training in safeguarding vulnerable adults from abuse (SOVA) during their induction. Their knowledge in safeguarding procedures varied. They had limited knowledge about the local authority's procedures but were aware of the need to report any abuse to their manager. There had been no updates in staff training since their induction. This meant that staff may not always have the knowledge to keep people safe.

Staff had not received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant that staff had not been given the information that they needed to help ensure that people were cared for safely.

We found many errors and omissions on the medication records. People told us that they had either missed taking their medication or taken it very late in the day because their carer had not arrived on time. One person's relative told us, 'There are discrepancies every single month. There are either too many tablets or tablets missing. I feel this is because weekend staff are either forgetting to give them or are giving too much.

Risk assessments had not been reviewed and updated to reflect people's changing needs. People reported many missed and late visits particularly at weekends.

This meant that people may not always be safe.

Is the service effective?

The service had not always completed its own assessments and care plans. There was insufficient information in the care plans to instruct staff on how to care for people safely and effectively.

People told us about calls being missed. One person said, 'I get a good service during the week but it is often erratic at the weekends.' Another person told us about them missing out on a social activity at their church because staff were late at the weekend.

Some care records were difficult to read due to the poor hand-writing. Issues noted in the daily communication logs had not always been followed up. This could mean that people do not get the care and support they need, therefore putting them at risk of harm or discomfort.

Is the service caring?

People told us that staff were, 'absolutely first class,' 'kind, understanding and helpful,' 'exceptional girls,' and 'treat me with respect and compassion.' People were very complimentary about their regular weekday carers. Most of the people spoken with told us that the problems arose at weekends when their regular carers were not at work. This showed that although people were cared for by kind and caring staff during the week, the missed, late and rushed calls at the weekends led to inconsistency in their care.

Is the service responsive?

People told us that they often did not receive the care described in their care plans at weekends. They said that staff were generally late, were rushed and sometimes did not turn up. People said that despite contacting the office with requests they were not always responded to. One person had repeatedly asked for the service to amend the time of their visit to facilitate an event at their local church. They said that, 'Staff do not always get here in time for me to go.' This meant that the service was not consistently responsive to people's needs.

Is the service well-led?

The registered manager left the service in July 2014 and it has been managed by an interim manager since that time. There were ineffective systems and processes in place for assessing and monitoring the quality of the service. The interim manager had not carried out any audits of the service's systems and processes. They told us that they had no access to monitoring records that may have been carried out by the previous registered manager.

The medication records had not been audited and we found many mistakes and omissions. Medication was being transcribed incorrectly by staff who had not received appropriate training and supervised.

The recruitment process was not robust because employment application forms had not been fully completed and references had not been sought appropriately. There was a lack of supervision and spot checks and staff told us that they did not feel fully supported to do their work.

This meant that there were risks to people who used the service and others due to the lack of effective quality monitoring systems.