10 November 2016
During a routine inspection
Enable Support Services - Stockton is a domiciliary care service which provides personal care to people within their own homes. It is based in Stockton and provides care and support to people in Redcar, East Cleveland, Middlesbrough, Stockton and Darlington. At the time of inspection the registered manager told us three people were receiving personal care.
Prior to this announced inspection concerns had been raised by the local authority regarding the number of safeguarding incidents that had been reported and investigated and the registered provider’s poor response to requested improvements. As a result of these concerns the local authority had made the decision to terminate their contract with the registered provider. The registered provider had been requested to submitted information prior to the inspection but not all the requested information was received.
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 will be inspected again within six months.
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.
Systems and processes were insufficient to protect people from the risk of harm. Safeguarding concerns were not accurately recorded and did not document outcomes of strategy meetings that had been held. The registered manager had failed to attend safeguarding strategy meetings when safeguarding alerts had been raised. Staff were able to tell us about the different types of abuse and what actions they would take if they suspected abuse was taking place but safeguarding alerts had not always been made when needed.
Risk assessments were not always in place for people who needed them. Associated risks had not been identified or recorded in areas such as medication and moving and handling. Risk assessments that were in place did not always correspond with information provided in the persons care plan or the information we were given by relatives and staff.
Robust recruitment procedures were not always in place. Appropriate checks of the suitability of staff transferring to the service from other providers had not been made. Recruitment documents such as application forms and references were not always available in staff files.
The service had policies and procedures in place to ensure medicines were managed safely but these were not always followed. People who were supported with medication administration did not always have the appropriate documents in place. The level of assistance required did not correspond with information in people’s care plans. Medicine records we looked at were not accurate and records we requested during the inspection were not available. The registered provider was given the opportunity to submit these documents following the inspection but failed to do so.
Supervisions had been completed for some staff but these were inconsistent and not completed for all staff. Appraisals had not been completed for any of the staff whose files we looked at during the inspection. Training records were inaccurate as the dates recorded did not always match training certificates in staff files. Some mandatory training was overdue and specialist training was not up to date.
Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
People told us they were supported to maintain good health and had access to healthcare professionals and services when needed but this was not recorded in people’s care records. People told us they were able to make regular visits to their own GP and staff would assist with making appointments when required.
Evidence of people and relatives being actively involved in care planning and decision making was not always documented. People had not always consented to care and treatment and care plans and care reviews were not signed by people. Information on advocacy services was available should this be required.
People and relatives spoke highly of the staff but told us that communication within the office and management required improvement and often information would not be passed on to the care staff by office staff. People said they were treated with dignity and respect.
Care plans were not always in place. Care plans that were in place did not detail people's needs, wishes and preferences and were generic and very basic. Care plans had not be reviewed and updated when required.
The service had a clear process for handling complaints which we could see had been followed.
Staff felt supported by the management of the service but, due to recent changes, they were not sure who the manager of the service was. Staff told us that office staff were approachable and they felt confident that they would deal with any issues raised.
Staff were kept informed about the operation of the service through regular staff meetings and these were generally well attended. Staff were given the opportunity to recognise and suggest areas for improvement. Staff confirmed they had attended staff meetings recently.
Quality assurance processes were not sufficient and many audits were incomplete. The audits did not always identify issues and when issued had been identified, action had not been taken.
During the inspection the registered manager was unable to locate requested documentation. Requests were made following the inspection for the information to be submitted to CQC. The requests were responded to but the information submitted did not correspond with the information requested.
Accidents and incidents were not monitored to identify any patterns or trends. Only three accidents had been recorded in 2016.
The registered manager understood their role and responsibilities but did not always take appropriate action to address concerns and issues or make appropriate referrals to other professionals. Notifications had not been submitted to CQC in a timely manner. Notifications are changes, events or incidents the registered provider is legally obliged to send us within the required timescales.
We found 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 reports after any representations and appeals have been conducted.