Archived: Exeter

Exeter – Lean on Me provides personal care to people living in their own homes. At the time of the inspection we were told by the location manager there were 19 people receiving personal care. However, we were informed by the local authority there were 20 people being supported by the service.

The service was last inspected in July 2015 where we rated the service as good with a breach of regulation relating to the completeness of employment files as the service recruited all their staff through the providers’ other location in Ealing.

During our inspection it became clear as we commenced visits to people’s homes on the first day of the inspection that despite the location manager acknowledging our request to inform people of our inspection on Friday 7 April 2017, people were unaware that we would be visiting. As the inspection continued we also discovered the location manager and the entire staff team had become unavailable after completing some morning visits and cancelling other visits earlier and had ceased carrying out all further personal care visits from around 09.00 with no notice to people expecting a care visit. Some people received up to four visits per day and care provided included assisting with meals, assisting with personal hygiene and helping people to bed. Some people were very vulnerable and living with dementia and others were immobile or nursed in bed.

Therefore, we immediately informed the local authority and worked in partnership with them throughout the day to ensure people would receive the care they needed and were safe that day and moving forwards. The registered manager/provider had also tried to locate the staff and location manager unsuccessfully and had informed the local authority.

Exeter – Lean on Me was managed locally by a location manager with support from a small staff team. The registered manager/provider who was based in London, where they were responsible for another location in Ealing, was in Exeter during our inspection. During this inspection we found the registered manager/provider showed very little knowledge of operations in Exeter. 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.

We were part of an on-going safeguarding process and the registered manager/provider had met with the local authority the previous week to discuss a complaint received from one person who was now no longer having support from the service. An incident report found in the location office dated 16 March 2017 indicated that although this had been investigated by the location manager they had not taken any action to ensure care workers were able to identify a medical emergency and support the person to ensure they were safe. They had also failed to respect the wishes of the family. During the meeting the local authority said the registered manager/provider did not have any previous knowledge of the complaint.

The registered manager/provider had made the decision during that meeting to give 28 days notice and cease providing a service by Exeter – Lean on Me by 4 May 2017. They were planning to meet with the location manager and staff on the first day of our inspection to inform them of their decision but on 10 April 2017 also discovered the location manager and staff team had become unreachable. They were unable to provide us with up to date client lists or staff team names as they could not access the location office or office computer without the location manager until the second day of our inspection. They remained unable to access the office computer. This meant they did not show clear oversight of operations at the location in Exeter to ensure there were safe contingency plans and good governance so people were safe.

We were unable to speak with the location manager or any of the staff team during our inspection. Therefore, we could not ascertain the majority of information we needed during the inspection such as the culture of the service, management arrangements and quality assurance, safeguarding, staff rotas, staff training, support and competency and medicines management.

People raised concerns when we visited them as some people had had a telephone call from the location manager on 10 April 2017 giving them very short notice that a care worker would not be visiting them that morning. People did not feel safe and some vulnerable people had had to try to look after themselves or rely on family members or carers and did not know when a care worker would be visiting again.

People also said they did not receive a staff rota so they did not know who would be visiting them to provide care. Although this was mostly the same care worker, they said there had recently received visits from care workers they did not know. People also raised concerns about why they had been asked by the location manager recently to call some care workers by a different name. These care workers were now signing the daily records with that different name. We were unable to discuss this with the location manager and the registered manager/provider could not offer any explanation for this.

There were also concerns raised about limited English language skills and ‘people skills’ of some care workers. There were occasions when care workers were late due to the workforce travelling by foot or by public transport. The local authority discovered that one person had had two episodes where they had not received care in the previous two weeks. This person was very vulnerable. People were also worried that care workers had not had a day off for long periods. Two people said this had been since October 2016 for some care workers. This indicated there were not sufficient or competent staff at the service to provide consistent, safe care and support for people.

The local authority also carried out reviews for each person as part of the safeguarding process and then to also ensure people were safe when staff became unreachable. Two people and the local authority informed us of concerns about a health and safety issue relating to one care worker. We were unable to view any health and safety risk assessments or discuss this with the location manager as they were unobtainable and the registered manager/provider did not know.

We looked at 26 employment files out of a large number of files held in the office which, although the paperwork looked complete, we could not match the files with the current staff list or meet any staff in person. The location manager had provided a staff list showing nine names including themselves. We were aware that one care worker had recently stopped working at the service. During the inspection we saw signatures of seven other care workers’ names in daily records who were not included on the staff list. We saw two files which could have matched with those names but did not see files relating to five care workers, although they could have been using different names. However, we could not confirm whether these files were kept or why care workers were using different names as the location manager was unobtainable and the registered manager/ provider did not know who was currently working for their service in Exeter. There was a large number of recruitment files kept at the location office and we could not look at them all. We also could not ascertain which staff were currently providing care to vulnerable people. This also indicated that the provider did not have quality assurance checks in place to be assured the location manager was running an effective and safe service which put people at risk.

Care records, however, appeared person centred and detailed how people liked to receive their care. People did not raise concerns directly about the personal care they received. Some people praised the care workers and clearly enjoyed their visits. Some care workers had been working with people for a long time and they were happy with the care provided albeit the concerns raised above. However, we looked at all the care files for each person receiving a service. Care plans, risk assessments and manual handling risk assessments were included but there was varied consistency and many had not been updated or formally reviewed for some time. We could not be sure that staff monitored people’s healthcare needs and, where changes in needs were identified, adjusted care to make sure people continued to receive care which met their needs and supported their independence.

The local authority during their reviews also found discrepancies with requests for some people to increase their care from the location manager in relation to people’s actual care needs. Local authority reviews did not always match with the needs highlighted by the service. Some people did not require the level of care requested and at least two people’s deterioration in health needs had not been highlighted to ensure they were receiving care which met their current needs. We were unable to discuss this with the location manager and the registered manager/provider did not know. However, they told us of an recent incident where information relating to one person’s needs had not been included in the care plan. This also indicated the provider did not have quality assurance checks in place to be assured the location manager was running an effective and safe service, again putting people at risk of not having their needs met.

We

During our inspection we visited five people using the service and four staff. We also talked with five people who used the service. We spoke to eight relatives, one advocate, one housing officer and two commissioning managers from the local authority.

People receiving the service spoke positively about the services. One person told us "I wouldn't want to change anything" another told us "They have helped me to regain my independence" People told us they were asked about their care needs, and their preferences in how that care was given, their changing care needs were discussed with those concerned, relatives and other professionals. They told us they were treated with respect and kept informed of any changes to the delivery of care. They felt their individual needs were catered for and supported, an advocate told us how a new carer ensured the person was comfortable with them, as any change upset them.

We saw how staff received training, which reduced the risk of vulnerable people being abused and observed safe working practises during our visit. We saw evidence of training having been provided and how working practises were monitored. We saw planning in place for future training needs, with individual needs identified. During routine monitoring and auditing of the services provided the people who used the service and their relatives and carers were involved in this process.

During our inspection we spoke with ten people using the service, five staff including two care coordinators. We also spoke with five people who were partners or relatives of people receiving services from the agency; two community nurses and two commissioning managers from the local authority. People receiving a service spoke positively about the services they received. One person told us, 'The staff are always polite and prompt' whilst another told us, 'The staff are very good, I've no complaints at all'.

People told us they were asked about their care needs and were consulted with about their changing care needs. They told us they were asked about what care they needed, and how care should be delivered by the care staff who supported them. This approach supported people's care and welfare needs and showed that they were consulted with about their care

We saw that how received training which reduced the risk of vulnerable people being abused and observed safe working practices during our inspection. We saw further training was planned to enable staff to update their skills and broaden their knowledge of the care sector. Where poor staff performance was identified we saw the provider took appropriate and proportionate action.

The provider routinely monitored and audited the services provided and involved people who use the service in the process.