Archived: Evoke Home Care

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

At the time of this inspection the service was providing support to 27 people who lived in their own homes, of these 23 people were receiving the regulated activity of personal care. Another four people received domestic assistance or companionship and this part of the service does not come within the remit of the registration. The service was provided to people who lived within the Bristol area. The service employed 14 care staff and three office staff.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 (part 4). You can see what action we told the provider to take at the back of the full version of the report.

There were insufficient care staff to meet the number of people being supported by the service at the time of the inspection. The service were using agency staff to fill the shortfall but people were not happy with the number of their care calls covered by unfamiliar staff. People did not always know which member of staff was planned to cover their care calls and they did not like this.

The service continued to not follow safe recruitment procedure which meant the potential for employing unsuitable staff placed people using the service at risk. The service had failed to act on the findings from the last inspection.

People were not receiving a person-centred service. The service provided was based upon the resources the service had to offer and did not always take account of agreed timings and length of care calls. Whilst there had been some improvement in late, missed and shortened calls people were still not satisfied with the service they were provided. Relatives described the service as unreliable and a great cause of stress for them. The service had failed to act on the findings from the last inspection.

The training arrangements for new care staff and for the existing staff team did not ensure they had the necessary skills to provide a good service. We found that the training for new staff being inducted had been signed off in one or two days and a check on learning had not been carried out to check their learning. Sufficient improvements had not been made to ensure existing staff we all up to date with their mandatory training. The service had failed to act on the findings from the last inspection.

The registered provider did not have a system in place to handle and act upon any complaints made about the service. People and their relatives told us about concerns and complaints they had raised but these were not logged. There was no record of any actions taken. The service had failed to act on the findings from the last inspection.

The registered provider and all other personnel brought in to make improvements to the service did not have sufficient insight to the legislative requirements in delivering a care service. The registered provider was unaware of the need to display their quality rating poster so prospective service users or staff could judge whether they wanted to use the service. The registered provider had failed to keep their statement of purpose up to date. The statement of purpose sets out the aims and objectives of the service so that people know what to expect.

The registered provider did not quality assurance systems in place to check on the quality and safety of the service. This meant the registered provider was not aware of how the service was complying with the Health and Social Care Act 2008 and could not make improvements. The service had failed to act on the findings from the last inspection.

All care staff were expected to complete safeguarding adults training and records showed all staff were up to date with this training. The service was still the subject of on-going organisational safeguarding monitoring but no further concerns had been raised since the last inspection. The acting manager and senior staff were still waiting to attend local authority safeguarding training.

As part of the care planning process a range of risk assessments were undertaken to ensure people being supported and care staff were not harmed. All work activity tasks were risk assessed including moving and handling tasks.

Where people needed support with their medicines, a plan of care detailing the exact help they needed was in place. Care staff were supplied with personal protective equipment to enable them to prevent any infection being spread. Where people needed support with eating and drinking, or for contacting health care professionals, they were supported by the care staff. The level of support the person required was detailed in their care plan.

There was a lack of consistency in the effectiveness of the care and support provided because people received assistance from many different staff. People were not provided with a person centred service that met their assessed and identified care and support needs. It was the practice they were provided with whatever resources could be arranged on a given day. The service provided was not effective and people’s relatives had to pick up the shortfall.

Each person had a well written plan of care written, however, the service they received did not match these care plans. The plans were detailed and provided a good pen picture of the person and their family and working life but the way the service was arranged did not enable the care staff to deliver that care and support.

Care staff asked people to give verbal consent before they offered any assistance. They only received minimal training in respect of the Mental Capacity Act 2005.

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

At the time of this inspection the service was providing support to 67 people who lived in their own homes, of these 49 people were receiving the regulated activity of personal care. Another 18 people received domestic assistance or companionship and this part of the service does not come within the remit of the registration. The service was provided mainly to people who lived in Bristol, with a small number of people who resided in North Somerset and South Gloucestershire also receiving the service. The service employed 28 care staff.

There are changes that needed to take place regarding the registration of this service because amendments to the legal status of the registered provider had not been communicated to the Care Quality Commission (CQC). This will be acted upon following this inspection. Previously the registered provider had managed the service on a day to day basis, however following their retirement a manager was appointed who then registered with CQC. The registered manager left in November 2016, a registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Prior to this inspection, the registered provider had not been in day to day contact with the service and for the last nine months a manager (not registered with CQC) had carried on the regulated activity of personal care.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 (part 4). You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

The service was not following safe recruitment procedure which meant the potential for employing unsuitable staff placed people using the service at risk.

People were not receiving a person-centred service, their care calls were not being delivered at the time that had been agreed and were on occasions being cut short. People told us about missed care calls. There were insufficient care staff to meet the number of people being supported by the service at the time of the inspection.

Care staff would benefit from more robust training to ensure they were able to meet people’s care and support needs appropriately. Examples include dementia awareness and Mental Capacity Act 2005 training since the service is provided to people living with dementia.

People and their relatives told us they had raised concerns and complaints with the manager or the registered provider but they had not been handled correctly. The registered provider did not have effective quality assurance measures in place to check on the quality and safety of the service. Although people and care staff were asked for their views, nothing was done about the response they gave. The registered provider was missing the opportunity to make improvements to the service.

The registered provider had not kept their statement of purpose up to date or provided a service to people that met the aims and objectives referred to in the document.

Although all care staff received safeguarding adults training as part of their mandatory training programme, we were told of examples when some staff had been rude and one person had been hurt because care staff had used moving and handling equipment incorrectly.

A range of risk assessments were undertaken to ensure people being supported and care staff were not harmed. All work activity tasks were risk assessed including moving and handling tasks.

Where people needed support with their medicines, a plan of care detailing the exact help they needed was in place. Where people needed support with eating and drinking, or for contacting health care professionals, they were supported by the care staff.

People were very complimentary about the kindness of the care staff however there was a consistent message that they could only do their best. Care staff told us they continually had to take on extra work and this affected their ability to do a good job.

Each person had a plan of care written. These were detailed and provided a good pen picture of the person and their family and working life. However, the service they received did not match these care plans.

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 spoke with six people and two relatives of people who used the service. We also spoke with four members of staff and the registered manager who supported the people who used the service.

The people we spoke with who used the service all provided positive feedback regarding their experience of the service. Comments included 'it's going fantastically well' and 'the staff are really nice and easy to talk to'.

People told us that they were involved in discussions about their care and support. There were robust arrangements in place that demonstrated that consent had been provided in relation to the care received. People we spoke with were aware of the location and content of their care plan.

We viewed four care plans. Individual needs were established before the person used the service. We found that the care plans were detailed and specific to the individual's needs and preferences.

Recruitment procedures protected people from the risk of being supported by unsuitable care staff because references had been fully checked. They had checked that staff were of good character.

Staff were knowledgeable about the people they supported and they were provided with training appropriate to their roles. Staff were regularly supervised.

We found that the provider had robust systems in place to regularly assess and monitor the quality of the services provided.

We spoke with five people and two relatives of people who used the service. We also spoke with three members of staff, a team leader and the assistant manager who supported the people who used the service.

The people we spoke with who used the service all provided positive feedback regarding their experience of the service. Comments included 'the staff are brilliant', 'if you need help you just call' and 'I am completely satisfied with the service'.

We viewed four care plans. Individual needs were established before the person used the service. We found that the care plans were detailed and specific to the individual's needs and preferences.

People advised that they were involved in making decisions about their care and support. One person advised that their 'views are definitely taken into account' and 'independence was encouraged'.

Staff were knowledgeable about the people they supported and they were provided with training appropriate to their roles. We found that staff were regularly supervised and appraised. One staff member advised 'I feel confident to express my views' and 'I definitely feel supported by my managers'.

We found that the provider had robust systems in place to to regularly assess and monitor the quality of the services provided.