17 January 2017
During a routine inspection
Stone House Business Centre is a domiciliary care agency providing personal care and support to people in their own homes in Oxfordshire. At the time of the inspection there were eight people using the service.
At the time of our inspection the service did not have 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 provider did not adequately assess risks for all people using the service. We found one instance where risk assessments had not been carried out for a person with identified risks clearly detailed in their hospital discharge files. Some of the risk assessments were in a lengthy tick box format and did not provide staff with enough guidance on how to recognise risks, what actions to take or how to mitigate the identified risks.
Medicines were not managed safely. Medicines were not always accurately recorded on the Medicine Administration Records (MAR).Staff did not receive medicines competency check. These factors increased the risk of that errors in medicine administration may occur
The service was not always safe. People’s relatives told us the service did not ensure sufficient staffing levels, which caused staff to miss or be late for care visits. There were no systems in place to monitor missed visits.
Care planning varied. Some people had care plans which were well designed and comprehensive. Other care plans were less thorough. We found one person who did not have a care plan. This meant that there was no clear guidance for staff on the care needs of people who used the service.
Staff did not receive effective regular supervision or annual appraisals. Staff were not always appropriately trained to ensure they had the skills and knowledge to meet people’s needs.
Systems to monitor the quality of the service were not effective. Audits of people’s care files and MAR had not been carried out regularly and had failed to identify issues found at this inspection.
There were no contingency plans in place in case of an untoward event. People were at the risk of not having the service delivered in scenarios such as staff sickness or bad weather conditions.
People were not supported in line with the principles of The Mental Capacity Act 2005 (MCA) and people's consent to care. Most people had provided consent to their care and treatment in line with legislation and guidance. However, the provider did not follow the appropriate legislation and guidance, or maintain appropriate records, when providing care to people who lacked capacity to consent to their care. Staff had not received training in MCA. The acting manager did not have a clear understanding of their responsibilities in relation to the Act.
People and their relatives told us they were treated with dignity and respect. Staff were able to give examples of how they promoted dignity. People were encouraged to be as independent as possible.
The provider had a complaints policy and procedure, and written complaints were investigated and responded to. However, verbal complaints were not always responded to. Feedback received from people was not analysed to identify trends and reported concerns were not followed up. This did not enable any learning to take place following concerns which may prevent reoccurrence and improve the service that was delivered.
People, their relatives and staff gave us mixed feedback about the approachability and availability of the acting manager. Some people and staff found the manager open and approachable while others told us the manager was difficult to get in touch with and was reluctant to listen to feedback.
The service was not operating with the name and location that had been registered with the CQC.
The acting manager demonstrated a lack of understanding of fundamental standards and their regulatory responsibilities. The acting manager had not sent in statutory notifications and had not submitted information requested by us within a set timeframe. There were no effective systems and processes in place to assess and monitor the quality of the services provided. This meant people's welfare, health and safety were put at risk as the service was not effectively managed.
Overall, we found significant shortfalls in the care provided to people. We identified breaches of regulations 9, 11, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two breaches of the Care Quality Commission (Registration) Regulations 2009. 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.
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.