30 June 2016
During a routine inspection
This was an unannounced inspection which took place over five days between 30 June and 11 July 2016. The inspection was carried out by an adult social care inspector.
The service did not have 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. There was a new manager who told us they would be applying for registration.
We followed up some prior concerns we had regarding how people were being safeguarded from possible abuse or mistreatment. One person had been subject to inappropriate care which undermined their rights and welfare. The agency’s current systems regarding safeguarding were not robust enough to identify and report issues of concern.
Medicines were not administered in line with the agency’s policies and procedures. Care staff’s competency to administer medicines was not effectively monitored.
Although people we spoke with assured us they felt safe using the agency we found a lack of evidence to assure us that care staff had the necessary qualifications, skill and experience to carry out care tasks. Risks to people had not been thoroughly assessed with reference to specific care needs. This put people at risk.
We found staff were not supported by on-going systems such as training, supervision, appraisal and staff meetings. Most staff employed did not have formal qualifications in care to evidence baseline skills and knowledge to carry out effective care.
At the last inspection in May 2015 we found concerns with the recruitment of staff in that the agency’s processes were not thorough in ensuring required pre-employment checks were made. On this inspection the agency’s recruitment processes were not robust enough to help ensure staff employed were fit to work with vulnerable people.
Most people using the service were able to understand and consent to their care. We saw that people’s consent to care was recorded in care files. One person lacked capacity to make decisions regarding their care and we found a lack of knowledge by staff regarding the principles of the Mental Capacity Act 2005.
Local health care professionals, such as the person’s GP, were involved with people and staff from the agency who liaised when needed to provide support. This helped ensure people received good health care support.
The feedback we received on the inspection evidenced a caring service. People being supported and their relatives commented positively on how the staff approached care. However, a recent safeguarding issue raised concerns around staff’s understanding of the principles of privacy, dignity and confidentiality for one person.
All family members and people spoken with on the inspection felt confident to express concerns and complaints. Issues were dealt with and the service was responsive to any concerns raised.
Both managers understood the concept of a ‘person centred approach’ to care. Meaning care was centred on the needs of each individual rather than the person having to fit into a set model within the service. People using the service, relatives and staff told us they felt the culture of the organisation was fair and open although there had been concerns in the recent past. They felt things were better now.
We enquired about the quality assurance systems in place to monitor performance and to drive continuous improvement. We had identified a number of concerns and breaches of regulations during our inspection and we found there had been a lack of monitoring by the provider and previous manager over the last three or four months in particular.
The provider and manager received our feedback positively.
The concerns we identified are being followed up and we will report on any action when it is complete.
Special measures.
The ratings for the key question ‘Is the service safe?’ and ‘is the service well led’ are ‘inadequate’. This means that the service 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.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.