Archived: S & T Home Care Limited

The Registered Manager who is also proprietor of S & T Home Care Limited was legally obliged to send us a report in response to our October 2011 inspection to let us know what action they were going to take to improve their service. This has not been received.

In January 2012 we were informed of issues of concern relating to this service. We were informed that the service had deteriorated and resulted in people being at risk of harm due to a high number of missed calls between November 2011 and January 2012 . We were also informed that new staff were reported to be working for the agency without having proper checks to confirm they were appropriate to care for vulnerable people. We shared these allegations with the local authority who started an urgent investigation and confirmed several of the allegations to be valid. They took immediate action to make sure that the service people received was monitored closely until the agency had improved its systems.

We confirmed that over half of the eleven people who used the service never received the care they required at the time it was needed on numerous occasions. People commented that staff had regularly failed to turn up to look after them especially during the winter holiday season. People who required their needs to be met by two care workers reported that only one staff member turned up to carry out their support on several occasions. People were upset about this inconvenience, as this had affected their comfort and well-being.

People were also unhappy that they no longer knew which care workers were coming to carry out their care. Other people expressed concerns that they felt the carers did not have the expertise required to look after them properly. The Registered Manager was fully aware of these concerns in January 2012. Although they committed to improve the service and take remedial actions we saw that actions they took were not effective. Lack of planning and organisation of the service meant systems failed and people did not receive the care they needed and paid the agency for.

By the beginning of February 2012 it was established that standards of care provided by the service were not consistent. Although there were some initial improvements they were not sustained and resulted in people being at an unacceptable risk of harm due to not receiving the care they required when they needed it.

Our inspection findings confirmed that the Registered Manager was fully aware that people were unhappy and that they were not confident about the reliability of the service. None of the negative comments people shared with the agency in January 2012 were acted upon. People felt they were no longer involved in their care and treatment as they used to be and even though they told the Registered Manager themselves how they felt, nothing had changed.

The Registered Manager continued to offer us assurances that systems had been improved and that they would fully cooperate with the local authority investigation to keep people safe. Although they agreed to carry out several actions to protect people they were supporting, our findings confirmed very few changes to practice had been put in place.

Although the Registered Manager agreed to carry out a thorough investigation to find out why so many people did not receive their care calls this was not carried out.

It is a further concern that a month later we were made aware that the Registered Manager had been working in the community when a vulnerable person did not receive their bedtime visit. The Registered Manager had not checked everyone had received their calls even though they knew the consequence of this failing would put people at further risk.

We were given inaccurate information by the Registered Manager in their attempt to demonstrate people were being cared for by staff that were fit to work with vulnerable people. The Registered Manager told us that appropriate checks had been carried out on all of the staff employed by the agency. Our findings confirmed this was not the case. There had been no improvement in staff recruitment and training systems since our last inspection visit. This had meant people had received care and support from people who have not been checked as suitable for their role as a care worker.

The Registered Manager informed us that two staff members had been disciplined for putting the well-being of people using the service at risk as a result of not receiving their care visits. When we visited the service we found that this had not happened.

At our October 2011 inspection we reported concerns that lack of care management and paperwork meant staff did not have the appropriate guidance to follow to look after people properly. We saw there had been little improvement in these processes. We are aware of at least two people with specific care needs not being looked after properly as a result of this failing.

The Registered Manager offered us assurances that people who required help with medication were receiving it in a way that their doctor had prescribed it. The Registered Manager told us they had made sure safe working systems for medication administration were in place. We could not find adequate paperwork to confirm this had been carried out effectively or safely.

People using the service had expressed concern that some staff did not seem to know what they were doing and had questioned whether they had received the right training. This was a concern we reported following our October 2011 inspection. Lack of improvements by the Registered Manager meant we could not be assured that staff had the right knowledge and abilities to care for people in the way that they required it.

We saw that inconsistent management arrangements by the Registered Manager had resulted in an unsatisfactory care service being provided by the agency. Although the Registered Manager had developed systems to monitor the quality of the service they provided in January 2012, they failed to respond appropriately when issues of concern had been identified.

We were aware people had made complaints and they had not been acted upon by the Registered Manager. As a result we were able to confirm at least two of the eleven people using the service had continued to be vulnerable. This was because the Registered Manager had not acted upon the negative information people had shared with them.

Lack of remedial action taken by the Registered Manager since the beginning of 2012 had meant there had been inadequate improvement in the management systems to put things right.

Before our inspection visit in February 2012 the Registered Manager assured us that they had appropriate records to demonstrate they were protecting people by operating a safe service. This information was not correct. Some records the Registered Manager told us they had kept were not available as they did not exist. These findings do not offer us assurance that the agency is managed appropriately and effectively to the professional standards we expect to keep people safe and comply with our legislation.

We have taken enforcement action against the provider for this essential standard to protect the health, safety and welfare of people using this service.

We were told,

'I am happy enough with my carers ".

'They are the best set of carers we have known. We have been very lucky with this agency. They always ring if they are going to be five or 10 minutes late ".

People told us that their privacy and dignity is respected at all times and that staff are sensitive when carrying out personal care with them.

People told us the information they were given from the agency and what they read on their website gave them confidence the agency would be a good choice. One person told us,

'We got a lot of information from the manager about the agency which told us everything we needed to know.'

However, our findings confirmed that some of the details the agency told people about the services they provide were not accurate. The website for S&T Home Care Limited advertises that they employ experienced carers trained to provide all of the care people need. This is not always the case, and we provide details about this later in the report.

We looked at the written information the manager of the agency told us she gives to people when they are thinking of using the agency for help with their personal care needs. We could not find evidence to validate some information S & T Home Care Limited tells people about this service. People could be misled about the agency telling them that they offer a service of the highest quality to professionally meet people's needs to the highest standards.

Social care professionals who have recently been monitoring the service have reported some basic standards we expect from an agency providing personal care in people's homes have not been met. We are aware that the agency was advised to improve their management systems including the way they communicate with people, and safe working systems for staff and the people they support. Two professionals shared our own findings that staff recruitment and training needed to be improved.

In the main, a general lack of management systems combined with recordkeeping not being available meant we could not validate the satisfactory level of service people say they have received is being carried out safely.

It is our expectation that every service that is registered with us has robust management systems in place to make sure that they keep people as safe as possible when they receive care in their home.

Immediately after our visits to this service we contacted the local authority department which monitors health and safety and environmental health issues for companies like this agency. We are aware that S & T Home Care Limited has been given two months to improve the services they provide and to demonstrate they are complying with the relevant legislation they need to.