14 April 2016
During a routine inspection
MiHomecare Wiltshire is a large domiciliary care agency, which provides care and support to people in their own homes on a short and long term basis. The agency manages the local authority’s Help to Live at Home contract.
At the last comprehensive inspection, which took place on 16, 26 January and 6 February 2015, we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not delivered in a way which met people’s needs and missed visits were occurring. There were also insufficient staff to meet people’s needs, medicines were not being safely managed and staff had not received adequate training to do their job effectively. In addition, the agency’s auditing systems were not identifying and addressing shortfalls in the service. After the inspection, the provider wrote to us to say what they would do to meet these legal requirements.
We carried out another inspection of the service in September 2015. This was to ensure the provider had been following their action plan and making the improvements required. Progress had been made, especially in terms of the reliability of the service. However, at this inspection improvements had not been sustained and there were widespread shortfalls in the majority of the areas looked at.
The agency had a registered manager in post. 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. The registered manager was present throughout the inspection.
There were not enough staff to ensure people received their planned visits. Due to this, a proportion of all visits were regularly given to another care agency to complete. This did not ensure consistency. In addition, the staff team were working at full capacity. This meant if a member of staff called in sick at short notice, there was little flexibility with arranging cover. Staff shortages and errors in communication had caused some missed visits. Staff had not always ensured follow up action had been taken, when staff could not gain access to a property. These shortfalls placed people at risk of significant harm.
People’s medicines were not managed safely. Records did not show clear instructions of the medicines prescribed and not all information was up to date. Staff had not signed the administration records appropriately and had not received up to date training in medicine administration. Staff’s competency to administer medicines and specialised training to administer prescriptions such as eye drops had not been undertaken.
Not all staff had received up to date training to do their job effectively. Staff were not regularly meeting with their manager to discuss their work and any concerns they might have. Spot checks to monitor staff’s practice were not taking place, in accordance with the agency’s policy. There was little evidence that staff received support when requested.
People’s care was not regularly reviewed and specific issues such as resistance to care had not been identified and addressed. The scheduling of people’s visits was not always conducive to people’s needs. There was some concern about the consistent timings of visits. However, those people who received regular staff to support them were very complimentary about the service they received. There were positive comments about the qualities of staff and their willingness to assist, where they could. People told us staff promoted their privacy and dignity although the shortage of staff sometimes impacted on this.
Systems in place to enable the management of the service were not always effective. Checklists or schedules did not show when certain practices such as staff supervision should take place. There were no systems to ensure staff had valid identity badges or their documents for car safety were up to date. Shortfalls in the service were not being identified and appropriately addressed. People had been asked for their views about the service by an annual telephone survey. However, more regular contact to monitor on-going quality had not been undertaken.
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, 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.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.