Archived: Greenwich Association of Disabled People

Updated 27 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

We undertook a focused inspection on 14 July 2015. This inspection was completed to check if improvements had been made to meet the legal requirements for the breach to Regulation 17 we found after our comprehensive inspection on 11 March 2015. We inspected the service against one of the five questions we ask about services: is the service well led. This is because the service was not meeting legal requirements in relation to this question.

This announced inspection was undertaken by one inspector. The provider was given 48 hours notice to make sure that someone would be available to assist our inspection. Before our inspection we reviewed the information we held about Greenwich Association of Disabled People.

During the inspection we spoke with the Chief Executive Officer (CEO), the newly appointed agency manager, a field supervisor and an administrator. We looked at 12 people’s care records, six personal assistant recruitment files, medicines records for two people and supervision records for six personal assistants, as well as records relating to the management of the service.

Updated 27 January 2016

We carried out an announced comprehensive inspection of this service on 11 March 2015.

Breaches of legal requirements were found. Risks were not being managed well as risk assessments and care plans were not always in place in relation to all risks to people. Medicines management was unsafe due to the recording and auditing systems in place. The system for recording medicine administration was error-prone, and omissions in recording were not always identified and investigated. Recruitment systems were unsafe as they did not ensure a full employment history was taken for personal assistants (PAs) and that gaps in their employment histories were explored. In addition, the agency did not routinely collect evidence that people had the right to work in the UK. People were at risk because PAs were not well supported through a system of supervision, appraisal and training to carry out their roles. Most PAs did not understand their responsibilities under the Mental Capacity Act 2005 and most had not received training in this.

We found that the provider’s quality monitoring systems were ineffective as they had not identified the issues we found. We took enforcement action and served a Warning Notice on the provider requiring them to become compliant with Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations by 11 June 2015.

You can read the full report from the comprehensive inspection dated 11 March 2015, by selecting the 'all reports' link for Greenwich Association of Disabled People on our website at www.cqc.org.uk.

We undertook a focused inspection on the 14 July 2015 to check that the provider had complied with the Warning Notice. This report only covers our findings in relation to the follow up on the breach of Regulation 17 focusing on quality assurance and governance We asked the provider to send us an action plan telling us how and when they will become compliant with the other breaches. These breaches will be followed up at our next comprehensive inspection of the service.

At our inspection of 14 July 2015 we found that the provider had not taken the necessary action to ensure their quality monitoring systems were effective in the time we had specified in the Warning Notice.

The Chief Executive Officer (CEO) was open and transparent throughout our visit. She told us that the organisation had not made good progress since our March 2015 inspection and that, until recently, the agency had not had the necessary senior staff to carry out the changes and improvements required.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The current registered manager was not in post at the time of our inspection and we remain in contact with the Provider about the management of the service.

An interim manager was employed between May and June 2015 to start making improvements to the service but the CEO stated that much of this interim manager’s time had been spent on staffing issues and day to day management of the service and they had not been able to address our concerns with quality monitoring systems. A new agency manager commenced employment in July 2015 but they informed us following our visit that they had submitted their resignation with a leaving date of the 28 August 2015. A part time field supervisor had commenced work in the week prior to our inspection and was present during our visit.

No changes or improvements had been made to ensure that effective systems or processes were in place to assess, monitor and improve the quality and safety of the services provided.

Systems or processes for checking people received their medicines as prescribed were still inadequate. There were no changes or improvements being made to those systems or processes in place at the time of our March 2015 inspection.The way in which medicines administered to people were recorded was still unsafe. Staff had not completed any training to help ensure their competency to support people to take their medicines safely.

A comprehensive Safer Recruitment policy had been developed, but recruitment documents had not been updated in line with this to ensure a full personal history was taken for PAs and that gaps in their employment were explored.

There were no changes or improvements to the processes in place for care planning for service users. There was no structured system in place to make sure that each person’s support plan and risk assessments was regularly reviewed to ensure they were up to date and meeting their current needs. We required the provider to submit a detailed action plan immediately following this inspection visit to tell us how they would make sure that all care plans and risk assessments were up to date and ensure people were receiving safe care and treatment. This requirement was made in accordance with Section 64 of the Health and Social Care Act 2008.

Due to the seriousness of the concerns found at the inspection of 11 March 2015, the risks these posed to people using the service and  the fact that no action had been taken to rectify the concerns; following this inspection we took enforcement action. We served a notice to cancel the provider's registration to deliver personal care on 28 July 2015. This is now in effect and the  provider's registration with the Care Quality Commission to provide personal care has been cancelled.