Archived: Community Care North East

At the last inspection between November 2016 and January 2017 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The breaches were:-

Regulation 9 Person-centred care

Regulation 10 Dignity and respect

Regulation 11 Need for consent

Regulation 12 Safe care and treatment

Regulation 15 Safeguarding service users from abuse and improper treatment

Regulation 17 Good governance

Regulation 19 Fit and proper persons employed

We also found at the last inspection the provider was in breach of Care Quality Commission (Registration) Regulations 2009. The breaches were:-

Schedule 1 Registered Manager Condition

Schedule 3 Statement of Purpose

Regulation 18 – Notification of other incidents

We asked the provider to take action to make improvements. During this inspection we found continued breaches of the regulations listed above with the exception of Regulations 10 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 18 and Schedule 3 of Care Quality Commission (Registration) Regulations 2009.

There was not 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.

People and their relatives we spoke with during the inspection held mixed views on whether or not the service was caring. One person liked the staff who visited them and we observed one person engaged in a conversation with humour with two staff members. Another person described the staff as arriving and doing what they had to do, and then leaving without caring. Three relatives were frustrated with the service provided and felt they had received all possible excuses for lateness.

The service had identified risks to people but had failed to put in place risks assessments which detail to staff actions they needed to take to mitigate the risks. We found documents used in the service were not always accurate and up to date.

We found the service did not administer people’s medicines in a safe manner. There were not appropriate arrangements in place with relatives to ensure people received their medicine. Medicines which were required by people on an ‘as and when’ basis were not always documented with suitable guidance given to staff.

People and their relatives told us staff do not always arrived on time to deliver care. We found staff did not having travelling time between calls. One staff member told us they had been short staff and covered hours. We found the newly appointed manager was attending a recruitment event at a local college to recruit more staff.

People and their relatives had mixed views about whether or not the service could be described as ‘Caring’. However due to the deficits we found in the service the ability of staff to care for people was constrained by a number of factors including the lack of risk assessments, supervision and the need to get from one person’s home to another without having in place travel time.

Staff completed online training in their own homes and in their own time. There were no checks in place to confirm that the actual staff member completed the training or had absorbed the re required learning. Staff did not receive regular support through supervision.

The provider had in place an electronic monitoring system. This was a system used to monitor when staff arrived and departed from people’s homes. We found this was not being monitored effectively and missed visits had not been identified. The system was not monitored to check if staff spent the required amount of time providing people’s care. Calls to people who chose not to have staff use their personal landline were not monitored. This meant there were risks of people’s visits being missed and systems to reduce this risk were ineffective.

We found staff references did not include sufficient information to ensure people employed in the service were suitable for their role. Brief comments were written down after a telephone call to the referee which did not fully explore the prospective staff member’s fitness to work in the service. Following the inspection the provider told us this was a historical issue and did not reflect current practice.

The provider had introduced a four weekly cycle of spot checks on staff whilst they undertook their duties. Staff were not able to tell us which week they were working to. We found these had not been carried out in line with the provider’s plan.

Surveys had been carried out by the provider of people who used the service. In two people’s surveys they had said they were satisfied with the outcome of their complaints. The provider was unable to demonstrate what these complaints were and what actions they had taken.

We found new audit systems had recently been introduced into the service by the newly appointed manager. These had been used to monitor the daily care records. However we found staff had written about a person experiencing pain when they had applied a person’s topical medicine (a cream applied to the skin). We found the audit tool did not address the specific details of care given to each person.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. These are listed throughout the report. You can see what action we told the registered provider to take at the back of the full version of the report. Details of any enforcement action taken by CQC will be only be detailed once appeals and representation processes have been completed.

Following our inspection we wrote to the provider with our concerns and asked them to provide us with a remedial action plan. They provided us with explanations and actions with deadlines they intended to take. We visited the service on 28 July 2017 to verify if the actions had been taken. We found some actions had not been completed within the timescales and other actions were in progress.

At our last inspection of Community Care North East in April 2016 we reported that the registered providers were in breach of the following:-

Regulation 9: Person Centred Care

Regulation 12: Safe care and treatment

Regulation 13: Safeguarding service users from abuse

Regulation 17: Good governance

Regulation 18: Staffing

Regulation 18 (HSCA Registration regulations): Notifications

Regulation 19: Fit and proper persons employed

We took enforcement action (Warning Notices) for Breaches of Regulations 12, 17 and 19.

At this inspection we found there were further and continuing breaches of Regulations.

Community Care North East is registered with the Care Quality Commission to provide personal care to people who wish to remain independent in their own homes. The agency covers areas within County Durham and Gateshead.

62 people were using this service when we visited and there were 30 staff.

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.

People’s care plans were not person centred, detailed or written in a way that accurately described their individual care, treatment and support needs. Care planning was not consistent and did not ensure that all staff were clear about how people were to be supported and their personal objectives met. Some peoples’ needs or complex conditions were not mentioned in care plans. Care plans were not regularly evaluated, reviewed and updated.

People were at risk of receiving inappropriate care and that reasonably practicable steps to reduce any such risks had not been taken.

There had been no registered manager for this service since March 2016. The provider had appointed an acting manager who could act for the provider during inspection three weeks prior to this inspection taking place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. We saw risk assessments which were required had not been carried out and others were not updated if new situations or needs arose.

We found the provider was not following safe recruitment procedures or applying the organisations own recruitment policy safely. The provider had not undertaken competent background checks for some staff before they started working with vulnerable people.

We found that the administration of medicines did not follow best practice guidance. The provider could not demonstrate that people were receiving their medication as prescribed. Administration procedures and systems to ensure the proper and safe management of medicines were not in place.

The provider’s arrangements to assess monitor and improve the safety of people supported by the provider was ineffective. People using the service had sustained accidental injuries whilst being supported by CCNE staff without these being known by senior staff or the acting manager. The provider’s arrangements to assess monitor and improve the safety of people supported by the provider was ineffective.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

We found the acting manager had an understanding about how the service was required to uphold the principles of the MCA, and when people needed additional support to ensure decisions about their best interests were robust and their legal rights protected.

Staff had not received appropriate specialised training to meet their needs of the people they supported. The providers’ training programme was not robust and did not support staff to gain the skills and knowledge they needed to meet the needs of people who used the service. This meant that persons providing care or treatment did not have the qualifications, competence, skills and experience to do so safely and measures to mitigate the risk to people using services were not in place.

The provider advertised on their website that the service was CCNE was a ‘City & Guilds Approved Centre of Specialist Care Training.’ The registered provider subsequently agreed that CCNE was not approved by City and Guilds and that this should have been removed from the website as it was misleading staff and the public.

Statutory notifications about important issues had not been made and records that the provider was required by law to keep, were found not to be in place.

People were not protected from the risk of abuse. The provider had failed to respond appropriately to incidents where abuse was suspected involving staff at the service.

At the last inspection in April 2016 we found the provider had moved the registered location from the address at Belgrave House without ensuring that registration with CQC at the new address had taken place. At this inspection we found the provider had again not met the requirements of their registration and had failed to apply to CQC to notify of the change of address.

The registered provider was offering services to support children without having submitted legal Notification to CQC that the providers’ ‘Statement of Purpose’ now included this service user group. The acting manager was also unable to demonstrate how the provider had ensured that legislation in relation to children such as The Children Act 1989 (and subsequent related legislation) were implemented.

Some people using the service did not have a signed agreement to indicate they had consented to the support offered by the provider.

We found that some people had not received the amount of staff time they had paid for and the acting manager was unaware of the shortfall. This showed that systems to monitor the performance of the service were ineffective and placed service users at risk of not receiving a service they needed, agreed and paid for.

The provider did not have effective systems in place for monitoring the quality of the service or using information to critically review the service. Feedback from relevant persons so the provider could continually evaluate and improve services was not in place.

The service had a complaints policy which provided people who used the service and their representatives with information about how to raise any concerns and how they would be managed.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. These are listed throughout the report. You can see what action we told the registered provider to take at the back of the full version of the report.

Details of any enforcement action taken by CQC will be only be detailed once appeals and representation processes have been completed.

Community Care North East is registered with the Care Quality Commission to provide personal care to people who wish to remain independent in their own homes. The agency covers areas within County Durham and Gateshead.

34 people were using this service when we visited and there were 28 staff.

The registered manager had resigned from their role immediately prior to this inspection. One of the partners had taken over the full time management of the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 found the provider was not following safe recruitment procedures or the organisations own recruitment policy. The provider had not undertaken competent and thorough background checks for staff before they started working with vulnerable people.

The provider could not demonstrate that people were receiving their medication as prescribed. We found some who remained at risk of inappropriate sedation and made a safeguarding adults alert to the local authority. This showed that arrangements to ensure the proper and safe management of medicines were not in place.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. We saw risk assessments which were required had not been carried out and others were not updated if new situations or needs arose.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

We found the partner in charge had an understanding about how the service was required to uphold the principles of the MCA, and when people needed additional support to ensure decisions about their best interests were robust and their legal rights protected.

Staff who had not received appropriate specialised training to meet their needs of the people they supported. The providers training programme was not robust and did not support staff to gain the skills and knowledge they needed to meet the needs of people who used the service.

People were complimentary about the staff who supported them and the positive relationships they had with their carers. Some people felt empowered to contact the provider when they were unhappy or where they wanted changes to be made. One person told us, “When they help me they respect my privacy.”

People’s care plans were not person centred, detailed or written in a way that accurately described their individual care, treatment and support needs. Care planning was not consistent and did not ensure that all staff were clear about how people were to be supported and their personal objectives met. Care plans were not regularly evaluated, reviewed and updated. People were at risk of receiving inappropriate care and that reasonably practicable steps to reduce any such risks had not been taken.

Statutory notifications about important issues had not been made and records that the provider was required by law to keep, were found not to be in place.

The provider had closed the partnerships Registered Office and operated from a variety of locations without due diligence to the continuity and safety of people using services and staff.

The provider did not have effective systems in place for monitoring the quality of the service or using information to critically review the service. Feedback from relevant persons so the provider could continually evaluate and improve services was not in place.

The service had a complaints policy which provided people who used the service and their representatives with information about how to raise any concerns and how they would be managed.

The records showed and the partner in charge confirmed that the service was successful in having only four accidents occurring since 2014.

People were not protected from the risk of abuse. When asked, the partner in charge was not able to describe the actions they had taken when abuse involving staff at the service, had been suspected.

You can see what action we told the provider to take at the back of the full version of the report.

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.

During our inspection we asked the provider, staff and people who used the service specific questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

Is the service safe?

We found some improvements had been made to ensure people were given their medicines, however, further improvements needed to be made to fully ensure people's safety.

Is the service effective?

We found measures had been taken to make sure staff were appropriately trained and supported.

Is the service caring?

People we spoke with were happy with the care they received. Comments from service users included 'I can't fault them. I feel safe. They (the care staff) know what they are doing,' 'I am happy with things up until now,' 'I'm pleased with everyone who helps,' and 'I would send them to the Queen they are good.'

Is the service responsive?

We saw improvements had been made to people's care plans. We saw these had been up-dated to provide step by step guidance to staff to make sure people received their care in the way they wanted.

People's complaints were not dealt with appropriately. One person had approached the Local Ombudsmen because of this.

Is the service well-led?

We saw that improvements had been made and spot checks by supervisors were being carried out to ensure staff were working to a good standard.

We saw supervision meetings (this is a meeting between a member of care staff and their supervisor and allows for the opportunity to discuss any care practice issues) had been introduced.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

Is the service safe?

We found staff had not been recruited by ensuring they had the appropriate knowledge and skills to work with people.

We found staff were not appropriately trained and supported.

We found the provider did not have in place safe arrangements for giving people their medicines.

We saw the provider did an annual check on people's homes to ensure people and the staff who worked in them were safe.

Is the service effective?

The provider was unable to demonstrate to us they did an assessment of people's needs.

People told us about how staff provided their care cared for them, we found these details were not recorded for any new staff.

Is the service caring?

One person said, 'At present I can't find anything wrong.' Another person told us, 'The girls are all very nice.' One relative said, 'Some carers are good, some are not so good.' We found people had no concerns about the care they received, one person said, 'No complaints.'

People's preferences, interests, aspirations and diverse needs were not all recorded and care and support was not always provided in accordance with people's wishes.

Is the service responsive?

One person told us they had made a complaint about missed visits to their relatives, but did not receive a response until they approached the local council.

Is the service well-led?

The service did not have in place adequate spot check arrangements to ensure staff were working to required standards.

Staff told us they did not have supervision meetings with their line manager. We found no member of staff had received an appraisal.

There was no system in place to confirm that a carer was suitably trained and competent to care for people once their induction had been completed.

People told us their care and welfare needs were met and that they were treated with dignity and respect. Everyone said they appreciated the way staff spoke with them or their family members and recognised the care workers used appropriate language and forms of address. However, for some people with complex health needs there were no risk management plans in place to guide staff and to ensure people's safety.

We looked at how peoples' medicines were handled by the agency during this inspection. We looked at the providers records and found lots of gaps where staff should have signed to show they had administered medication. We also saw the administration instructions which were needed for staff to follow were not always clear. This meant the provider could not demonstrate people had always been given their medicines as prescribed by their doctor.

Although staff told us they felt supported we found staff had not been provided with the training they needed to meet the diverse health and personal care needs of the people in their care.

We found appropriate checks were undertaken before staff began work.