Archived: Grove Domiciliary Care

Updated 19 April 2017

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.

This inspection took place on 14 and 15 February 2017 and was announced. The provider was given 48 hours’ notice of the inspection because the location provides a domiciliary care service and we needed to be sure the manager would be available.

The inspection team consisted of two inspectors and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The experts areas of expertise included, people in the early stages of dementia and older people who used regulated services.

Before the inspection we reviewed safeguarding records and other information received about the service. We checked if notifications had been sent to us by the service. A notification is information about important events which the provider is required to tell us about by law. We spoke with the Local Authority safeguarding and commission teams. This inspection was brought forward as a result of receiving concerning information about the quality and safety of the service.

During the inspection we spoke with 22 people who were in receipt of personal care and nine relatives. We spoke with the nominated individual of the provider who was also the regional manager, one deputy manager, two care coordinators and 16 care workers.

We reviewed a range of records about people’s care and how the service was managed. We looked at care plans for seven people which included specific records relating to people’s health, choices, care, capacity, finances, medicines and risk assessments. We looked at daily reports of care, incident, safeguarding, complaints and compliments logs, financial transaction sheets, medication administration records, policies and procedures, service quality audits and minutes of meetings. We looked at recruitment and supervision records for ten staff and training records for 64 members of staff.

Updated 19 April 2017

This inspection took place on 14 and 15 February 2017. The inspection was announced.

At our last inspection carried out on 17, 27 and 30 June 2016, we found the service was in breach of seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (2014 Regulations) and one of the Care Quality Commission (Registration) Regulations 2009 (2009 Regulations). We served warning notices for breaches of four of the 2014 Regulations because people’s medicines were not being managed safely, there were no systems in place to monitor the quality and safety of the service, there were not enough sufficiently skilled and experienced staff to meet the needs of people and keep them safe, and the provider did not operate an effective recruitment procedure to ensure staff were suitable to provide care to people. We told the provider they were to be compliant with these warning notices by 16 December 2016.

At this inspection we found the provider had not met the warning notices because the service continued to not manage people’s medicines safely, systems were still not in place to monitor the overall quality and safety of the service, there continued to be insufficient staffing levels and staff were not sufficiently skilled and experienced to meet the needs of people and keep them safe. Recruitment checks remained incomplete prior to staff starting work.

We asked the provider to send us an action plan in response to the breach of three of the seven 2014 Regulations and one of the 2009 Regulations from the June 2016 inspection. We asked the provider to tell us what action they would take to meet people’s needs and keep them safe. This was because people’s needs may not have been met or met safely because care plans were not in place for people at the start of them receiving a service, safeguarding concerns had not been reported, identified and appropriately investigated, appropriate action had not been taken in response to complaints and the provider failed to notify the Commission of safeguarding concerns. The provider sent us an action plan on 5 October 2016, which stated they would be compliant with the Regulations by the 5 October 2016. At this inspection we found the provider had not met their action plan or the requirements of the Regulations because safeguarding concerns had not been identified and appropriately investigated and the Commission had not been notified of all safeguarding concerns received. Complaints were not investigated or responded to within given timescales.

Grove Domiciliary Care is a domiciliary care service, which provides care and support for people who live in their own homes in Fareham, Portchester, Warsash, Lee on Solent, Stubbington, Gosport and Portsmouth. At the time of this inspection, they provided care and support to an estimated 181 people with a range of needs including older people and those who lived with dementia. People were supported with personal care, medicines administration and meal preparation. The service employed a registered manager, a deputy manager, 74 care workers, three senior care workers, three care coordinators, two drivers who would transport care workers to visits who did not have their own mode of transport, and administrative staff based at the office premises.

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. However the registered manager had been absent from the service since the 30 November 2016 and the provider’s regional manager who was also the nominated individual of the provider was overseeing and managing the service in the registered manager’s absence.

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. However the registered manager had been absent from the service since the 30 November 2016 and the regional manager who was also the nominated individual was overseeing and managing the service in the registered manager’s absence.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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.

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.

Missed and late visits frequently occurred and staff were rushed resulting in poor manual handling techniques, incomplete care visits which resulted in neglect and care visits being too close together which resulted in people missing medicines and food and fluids.

People’s dignity was not respected as a result of missed visits because it was apparent the service expected relatives to complete people’s care when staff were unable to visit. People felt rushed and staff’s attitude to this demonstrated they were not consistently kind or caring.

Risk assessments did not contain sufficient information to keep people safe from harm and manual handling equipment was being used incorrectly.

Medicines were not managed safely. Records were unclear regarding the support people required with taking their medicines. There were gaps present on peoples Medicine Administration Records and people were not receiving the right dose of their medicines or their medicines at the right time.

Appropriate recruitment checks had not been completed for all staff prior to starting work.

Safeguarding concerns were not managed appropriately to keep people safe from harm. A number of safeguarding concerns had been raised against the service. However records relating to safeguarding concerns were not accurate or up to date. The Commission had not been notified of all the safeguarding concerns received by the service. The overall feedback from external professionals was that people were not safe from abuse or harm from this service.

Staff had not received appropriate training to help them to complete their role effectively and safely. Not all staff had not received practical manual handling training and not all staff had received training on medicines. Medicines competency checks had not been carried out on those staff who had completed the medicines training. Not all staff had completed training on the Mental Capacity Act 2005 and people may not have consented to their care plans.

People’s care plans were not personalised and lacked sufficient detail about how people would like to receive their care. Care plans did not include information on what people could do for themselves. Information contained within the initial assessments were insufficiently detailed, contradictory and unclear and were not always included in people’s care plans. Care plans in people’s home were out of date and did not contain the correct information.

The emergency out of hours service which was in place when the office was closed was not responsive and often switched off. Complaints had been received but were not investigated or responded to and there was no learning from complaints.

There was inadequate leadership within the service. People and staff did not feel that management were open and transparent and did not have confidence in the management team to deal with any concerns or issues.

The systems in place to assess the overall quality and safety of the service were inadequate and not fit for purpose.

People received support to seek advice from health care professionals. People felt listened to and

were encouraged to make decisions about their care.

We identified a number of breaches of the Health and Social Care (Regulated Activity) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

The Commission is considering the right regulatory response to the concerns we found.