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Archived: Greenwich Association of Disabled People

Overall: Inadequate read more about inspection ratings

The Forum at Greenwich, Trafalgar Road, Greenwich, London, SE10 9EQ (020) 8305 2221

Provided and run by:
Greenwich Association of Disabled Peoples Centre for Independent Living

All Inspections

14 July 2015

During an inspection looking at part of the service

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.

8 and 9 October 2015

During a routine inspection

This comprehensive inspection was carried out on 8 and 9 October 2015. We gave the provider two days notice of the inspection as we wanted to be sure staff could be available at the office without disrupting the service.

Breaches of regulations had been found at the last comprehensive inspection on 11 March 2015. A warning notice was served for the more serious breaches in respect of monitoring the quality at the service. We had asked the provider for an action plan in respect of the other breaches for assessing risks, recruitment, consent and staff training.

We carried out a focused inspection on 14 July 2015 to check on the more serious breaches from the March inspection. We found that these breaches had not been addressed. We took action to impose a condition to stop the service taking any more referrals and are considering any further appropriate regulatory response to the concerns we found. The provider was also asked to supply written information to us following this inspection. We carried out this inspection of 8 and 9 October to check that action had been taken to address the breaches found at both inspections and to provide a rating for the service.

Greenwich Association of Disabled People (GAD) specialises in providing personal care and support for people with a range needs including physical and learning disabilities, mental health, sensory needs and people living with dementia. It was originally set up as a centre offering a range of service to enable deaf and disabled people to be more independent through a range of

services and support programmes. It has a strong culture of empowerment for people using its service. There were approximately 33 people supported with personal care in their own homes at the time of the inspection.

There was a registered manager who no longer worked at the service and who had not voluntarily deregistered when they stopped work. CQC is working to ensure these registration issues are resolved. 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 had been two interim managers since the last comprehensive inspection and a third manager had started at the service in August 2015.

At this inspection on 8 and 9 October 2015 we found some action had been taken to try to address the issues we had found previously. Adequate recruitment checks were now being made. People told us that they felt safe and well cared for by the service. However our findings were in contrast to these views. We found further breaches of regulations in respect of identifying risks to people, managing medicines, staff training and quality assurance.

Individual risks identified from people’s records were not always identified in people’s support plans or guidance provided for staff to reduce risks. New systems had been drawn up to manage medicines safely however we found these were not being used by staff. The staff could not fully access their call monitoring system to check people had received their care as planned. There were insufficient arrangements to deal with emergencies.

Staff had not all received adequate training and support to meet people’s needs. Some staff had not received refresher safeguarding adults training or food hygiene training. Medicines training and training on the Mental Capacity Act 2005 had not been completed although further dates had been arranged. People’s support plans had not always been reviewed with them and may not therefore reflect their current needs. There was not always sufficient guidance for staff in support plans about how to provide care and support. There were inadequate arrangements to monitor the quality of the service and where issues were identified they were not addressed to improve the quality of people’s care and support.

CQC is considering the appropriate regulatory response to resolve the problems we found in respect of this regulation. We will report on action we have taken in respect of these breaches when it is complete.

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, It 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 consider taking appropriate action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. 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.

People told us they felt involved in their care and the service involved people at different levels such as on the board of trustees or in interviews for staff. They told us they received their calls on time and could contact the office in an emergency. Staff treated them with respect and dignity and supported them to be as independent as possible. There were enough staff to provide care and support to people. People were supported to have access to health care where needed. People told us their views were sought about the service through a questionnaire and they knew how to raise a complaint if they needed. Staff told us they felt supported to do their work and that the office communicated with them regularly through text messages.

11/03/15

During a routine inspection

This inspection took place on 11 March 2015 and was announced. At the last inspection on 18 and 23 June 2014 we found the service was meeting all the regulations we looked at.

Greenwich Association of Disabled People (GAD) specialises in providing personal care and support for people with a range of physical and learning disabilities and mental health needs. It was set up as a centre offering a range of service to enable deaf and disabled people to be more independent through a range of services and support programmes. The service supported 85 people in their own homes at the time of the inspection.

The service had 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.

Risks were not 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 by office staff 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 and we found three PA files lacked this evidence.

There were enough PAs employed to support people using the service.

People felt safe and PAs had a good knowledge of how to recognise and report abuse. However, they had not all received recent training in this. In addition, the risks of financial abuse to people were not being managed well due to a lack of risk assessment and auditing systems.

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. The Mental Capacity Act 2005 is in place for people who are not able to make some or all decisions for themselves.

People were positive about the PAs providing care and support to them and found them kind and caring. People were supported to access social activities and advocacy service.

PAs knew people’s preferences through working with them for periods of time but these were not always recorded. Although people told us they were involved in planning their care, their views were also not always recorded in their care documentation. This meant PAs did not always have this information to refer to in guiding them in supporting people appropriately.

People were supported appropriately in relation to food and drink and their day to day health needs were met. The agency supported people to access social activities and advocacy service, and were encouraged to participate in campaigns to promote the rights of disabled people.

People had confidence any complaints they made would be responded to appropriately. However, the action taken in response to complaints was not always recorded.

People and PAs were involved in running the service, including being involved in overseeing the service on the board of trustees’ sub-committee and on interview panels. The service regularly sought the views of people using the service and PAs through questionnaires and they felt listened to.

The service was not well-led. The manager did not protect people from the risks of inaccurate records in respect of people and medicines management.

We found a number of breaches during this inspection and found the provider’s quality monitoring systems were ineffective as they had not identified the issues we found.

The registered manager’s role was more strategic than operational and they were managing several other services for GAD besides the registered service, limiting the amount of time they could devote to the registered service. In addition, the number of breaches we found indicated they were not managing the service well and did not have a good understanding of their role as the registered manager.

18, 23 June 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were aware of the importance of consent and people were asked for their consent before care was provided. People's needs were assessed and risk assessments were carried out before care was provided. These were regularly reviewed so that staff were aware of the best way to provide support.

The manager and other supervisors were available on a daily basis and out of office hours to oversee the staff, and monitor that people were being safely supported, for example in helping people to be safe during personal care. The staffing levels were agreed appropriate to people's assessed care needs. We were told by staff and people who used the service that the agreed numbers of staff were available when providing support. And that staff were on time and responded to requests for additional support such as making telephone calls if requested.

There were arrangements in place to deal with emergencies and to make sure people were safe. People's health needs, such as epilepsy were included in their care planning to ensure that important health needs were met. The staff and manager were trained in protecting people from neglect or abuse. All of the 15 people we spoke with who use the service told us they felt safe and well looked after by staff in their home. They said they felt safe in the way staff supported them, and the staff were well trained and knew how to support them.

Staff carried photographic identification issued by the agency, to ensure that people who used the service were able to identify them and feel safe. All of the 15 people we spoke with who used the service or their relatives said that the staff always carried identification, and they felt that this was reassuring and gave them confidence.

Is the service caring?

We spoke with 15 people who used the service or their families and people told us that the staff and supervisors were very caring and supportive. Many said staff always took the time to speak with them and spoke with them in a manner they understood. One person said: 'the staff are very polite and nothing is too much trouble to them.' Another person said:' I think the standard is high, the staff are good people to have in my home.'

Is the service effective?

We saw from 10 people's records we looked at that people's needs were assessed and a plan drawn up to meet those needs. People we spoke with told us they were happy with the plan provided. Regular reviews were made of the plan provided and people or their families told us they were involved in the reviews. Four people told us that the agency allowed them a choice of staff at the start of their service provision, and care was taken to ensure they were happy with the staff allocated to them.

There were suitable policies in place for consent to care, assessing and planning care, safeguarding people, medication and quality assurance. All of the people we spoke with told us the staff knew how to support them well. People who used the service were consulted for their views on the service they received a regular basis, which involved the person, their family or advocate and social services. We saw that any changes they requested were included in a revised care plan.

Staff were provided with adequate support, guidance and training to do their job. They were experienced in supporting people with care needs such as dementia and physical disabilities and they told us that the training they received equipped them to support people with confidence.

Is the service responsive?

People we spoke with who used the service told us that the staff and manager always listen to their concerns and do something to help sort out any problems they are experiencing. People were asked for their views about their service and action was taken to address any problems, for example one person told us that their comments expressing concerns about not feeling comfortable with their allocated staff were listened to and resulted in a change of staff.

People's support plans were reviewed and changed when necessary in response to changing needs, for example in negotiating higher levels of support when necessary, or in changing the time of visits to accommodate people's needs such as activities.

Is the service well led?

The registered manager was qualified and experienced and was involved in the day to day management of the service. There was an out of office hours on call system in operation to ensure that management support and advice was always available. There was a system for doing spot checks on staff working with people to monitor the quality and safety of care provided. Comments received from people who used the service and families included: 'the supervisors are very good and regularly call in to see how the staff are doing, I once had a problem with one staff and it was dealt with immediately,'

Staff we spoke with told us that they felt the agency was very well managed and they received direction and training to help them to support people. Regular staff meetings and supervision sessions were held, and staff said they felt able to raise any issues with the management openly and honestly, and felt the manager followed up on any issues quickly.

People who used the service told us that they felt the agency was well managed and that they had regular contact from the office to check that their support was happening as planned.

There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed.

14, 21 June 2013

During a routine inspection

People we spoke with who used the service and their relatives told us that the staff were respectful and were providing good quality care. One person we spoke with said: 'I am extremely happy with the service, and if something needs doing the staff just get it done'. This was reflective of the majority of comments we received from people who used the service.

People told us that staff were always on time for their work, that they felt safe and had no concerns about the care they received. One person told us; 'I know the staff well for a long time and trust them, and their supervisor is often around to see me'. People we spoke with said they always got the same carers who knew them well.

People we spoke with who used the service told us they were involved in the planning of their care, and had been asked for their views when reviews were carried out. We reviewed information about six people's care and found that their care needs were being planned for with their involvement. We spoke with staff and found that they understood people's care needs and how to protect them from risk and harm.

We found that staff had adequate training and were supported by the management to do their job. Staff we spoke with said the management were very supportive and the training was good. Staff supervision and training was up to date. The provider used effective systems to regularly check that care was being provided safely and appropriately, and record keeping was up to date.

13, 20 February 2013

During a routine inspection

We spoke with seven people who used the service or their relatives. Six people told us they were very happy with the service they received, that the staff were professional and respectful, and they felt able to call the agency's office if they were ever concerned. All six people told us that staff were competent in providing care, and were always on time for their work. One person who used the service told us; the staff were not always that friendly and did not always follow the care plan. They said they felt confident to discuss this with the manager. Most people said they always got the same carers who knew them well and whom they trusted.

All of the people we spoke with who used the service told us they were involved in the planning of their care, and had been asked for their views when reviews were carried out. We reviewed information about six people's care and found that their care needs were being planned for. We spoke with staff and found that they understood people's care needs and how to protect them from risk and harm. However we found that care planning record keeping was not always up to date.

We found that staff had adequate training and were supported by the management to do their job. Six staff we spoke with said the management were very supportive and the training was good. However we found that formal staff supervision was not up to date. The provider used effective systems to regularly check that care was being provided safely and appropriately.