This inspection took place on 19 and 20 May 2015. We gave the provider 48 hours’ notice of the inspection so we could be sure that they were in for our inspection.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
- Ensure that providers found to be providing inadequate care significantly improve.
- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Healthcare Nationwide Ltd trading as Healthcare Assist provides support and personal care services to people in their homes. At the time of our inspection we were told that the provider had six people who were receiving a support or personal care service.
There was 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.
Our inspection identified serious issues about the adequacy of the infrastructure around care provision and the absence of operational management structures and managerial leadership. We found that the provider and registered manager had failed to take all reasonable steps to protect people from the risk of harm, in that they did not have safe and robust systems in place to protect people.
No systems were in place to ensure the service was operated safely and within the legal requirements. Records were not maintained and available to review when required.
There was no system to ensure the safe management of the deployment of staff and there were no systems in place to identify the numbers of staff required to meet the needs of the people.
Staff were not recruited in accordance with safe recruitment procedures which included a lack of references, vetting and checks on people’s right to work in the United Kingdom. Consideration was not given to the impact on staff who also worked elsewhere and the employment constraints on their visa.
There was little or no induction, training or supervision of staff delivering care with an over reliance on staff being trained by other employers for whom they worked or had previously worked. There were no systems to ensure that staff had the training they needed to complete their job role safely.
The provider did not carry out regular spot checks on the service being provided and staff performance whilst delivering care to people in their own home.
There was no governance arrangements or auditing of the service provided so the service was not able to learn and develop.
People were not able to provide formal feedback on the service as there were no systems in place to enable them to do so. .
The provider did not have in place safe and robust systems to safeguard people from harm and staff lacked the understanding on how to raise concerns if they arose.
People were not provided with information on the service charges and funding arrangements which caused them anxiety about who or how they should pay.
Support plans were in place which provided details on how to support people but were not always accurate and up to date. People had little opportunity to contribute to their plans of care.
People who used the service were not involved in making decisions about their care and support.
During this inspection, we found that the provider was in breach of the Health and Social Care Act (regulated activities) Regulations 2014. Due to the serious level of our concerns and the inadequate response from the provider when we requested further information, we took urgent action on 22 May 2015. We took steps under our enforcement powers to prevent the provider from carrying on the regulated activity of personal care to any person who was not already receiving a service with effect from 22 May 2015. The provider did not appeal this decision.