Background to this inspection
Updated
6 October 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 30 April and 3 May 2017 and it was announced. We told the provider two days before our visit that we would be coming. We gave the provider notice of our inspection as we needed to make sure that someone was at the office in order for us to carry out the inspection. Two inspectors carried out this inspection. At the time of this inspection there was only one person who used their service.
The provider had not completed a Provider Information Return (PIR) because this inspection was carried out at short notice. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We however, reviewed information we held about the service. This included any notifications and reports provided by the service and reports from the local authority and other agencies involved.
We spoke with the person who used the service. This person did not provide us with their view regarding the care provided. We also spoke with the operational manager, the director of the company, three care workers and the newly appointed manager who was due to start working soon. We also obtained feedback from the person's advocate and three care professionals.
We reviewed a range of records about the people’s care and how the service was managed. These included the care records for this person, four staff recruitment records, staff training and induction records. We checked the policies and procedures and the insurance certificate of the service.
Updated
6 October 2018
The inspection of New Beginnings Independent took place on the 30 April and 3 May 2018 and was announced. New Beginnings Independent is registered to provide personal care. The provider was given two days' notice because the location provides a care at home service where personal care is provided to people living in their own homes and we wanted to be sure there was someone in the office. At the time of this inspection, the service was providing personal care for one person.
The service did not have a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run. Since the previous inspection, the service had made an application to the CQC to register the operational manager as the registered manager. However, the CQC refused the application as the operational manager did not meet regulations in respect of qualifications, experience and competence. The operational manager had not been able to effectively manage the service. This had resulted in a number of deficiencies and breaches of regulations identified in this inspection. However, a new manager had been appointed and had applied to CQC to become registered. The operational manager still worked for the provider and was still managing the service on a day to day basis at the time of this inspection. We identified numerous problems stemming from the failure of the operational manager to adequately manage the service on a day to day basis and the provider for failing to adequately assure themselves that the service was running safely and that the needs of the person who used the service was being met. Deficiencies we noted included lack of references in the recruitment of care workers, issues with the phone, poor record keeping and inadequate scrutiny of financial arrangements for the person who used the service and the lack of consultation regarding decisions made.
The person who used the service had a learning disability and when asked, did not provide us with feedback regarding the quality of the care provided. We however, received feedback from an advocate and two social care professionals. They stated that they were not satisfied with the care provided and they had concerns regarding the management of the service.
The service had a policy and procedure for the administration of medicines. There were appropriate arrangements for the recording, administration and disposal of medicines. The person concerned had been given their medicines as prescribed. There were no gaps in the Medicines Administration Record chart examined (MAR).
The person’s care needs and potential risks to them were assessed and care workers were aware of risks to this person. A personal emergency and evacuation plan (PEEP) was prepared and care workers knew what action to take in an emergency. The service had guidance for care workers on lone working.
The service had arrangements for safeguarding people. There was a safeguarding adult's policy and care workers were aware of action to take when they suspected abuse had taken place. One safeguarding allegation of neglect had been reported to us prior to this inspection. This was investigated by the local safeguarding team and found to be substantiated overall. The concerns related to the way the person’s money was managed by the service and the lack of adequate social and mental stimulation. The service had responded and taken action to improve the care provided. This had included closer management support, better care documentation and ensuring that the person had sufficient funds available for their care needs.
We found that the service did not follow safe recruitment procedures. We examined four staff records. The record of one care worker contained no references. The record of a second care worker contained only one reference. We have made a requirement in respect of this.
Two care workers worked very long shifts ranging from two to three 24 hour shifts which included sleeping in duty. This places the person concerned at risk of not receiving safe and appropriate care. It also placed the care workers concerned at risk of tiredness and ill health. We have made a requirement in respect of this.
There was evidence that most care workers had received essential training which included health, administration of medicines, ensuring equality and promoting diversity and safety and safeguarding. New care workers had received a period of induction. Supervision and appraisals had been arranged for care workers.
We found that the service did not work in accordance with the principles of the MCA and consent had not been obtained for certain important decisions made for the person being cared for. The service had not consulted with either the person using the service or their representatives when changes were made to this person’s telephone network. No consultation was carried out when one of the activities this person had been involved in was changed and later stopped. We also noted that this person’s money had been used to purchase a microwave and landline phone. There was also no record of consent being given either by the person concerned or their representatives or best interest decisions recorded regarding these. We have made a requirement for this.
Care workers were caring in their approach and able to communicate with the person concerned. They were knowledgeable regarding the needs of this person. The person’s care plan contained information regarding their likes and dislikes, weekly activities, cultural and religious background. Care workers we spoke with had a good understanding of the importance of treating people with respect and dignity. The service had a policy on ensuring equality and valuing diversity. We however, saw no documented evidence of best interest decisions or consultation with this person since the last inspection in March 2017 regarding their preferred activities and items purchased on their behalf. A review of care had been carried out recently by the funding authority. They concluded that the person concerned was not receiving sufficient mental and social stimulation. The service had responded to this and more activities had been arranged.
Three care professionals and the advocate of the person concerned expressed disappointment with the management of the service. We identified several shortcomings in the management of the service. Some checks had been carried out. These were however, not sufficiently comprehensive and had not identified deficiencies noted such as the lack of references in the recruitment of care workers and inadequate scrutiny of financial arrangements for the person concerned. We are considering what action to take in respect of this breach.
The service had a complaints procedure. No complaints were documented. The manager stated that none had been received.
Infection control measures were in place. The premises had been kept clean with the assistance of care workers. The healthcare needs of the person concerned had been monitored and appointments had been made with healthcare professionals when required. There were arrangements for assisting the person with their dietary needs.
The service was not well managed and we identified several shortcomings and breaches of regulations. Although checks of the service had been carried out these were however, not sufficiently comprehensive and consistent and had not identified deficiencies noted such as lack of references in the recruitment of care workers, issues with the phone, poor record keeping and inadequate scrutiny of financial arrangements for the person who used the service and the lack of consultation regarding decisions made. These were brought to our attention following safeguarding investigations into a complaint made. Failings of the service had not been promptly identified and rectified by the manager and senior management of the service.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.