Archived: Zion Domiciliary Care Hampshire

We conducted this announced inspection on 19 and 20 November 2015, 2, 3, 8 and 9 December 2015, in response to concerns that had been raised regarding the quality of care being provided by Zion Domiciliary Care Hampshire, particularly the high volume of missed and mistimed calls.

Zion Domiciliary Care Hampshire provides a domiciliary care service to enable people living in Farnborough and the surrounding areas to maintain their independence at home. There were 50 people using the service at the time of the inspection, who had a range of physical and health care needs. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including Multiple Sclerosis and Diabetes.

At the time of our inspection the service had a registered manager. 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. During the inspection we were informed by the provider that the registered manager had resigned from their position on 5 December 2015, effective from the 7 January 2016.

People were not always protected from abuse and avoidable harm. Where abuse had been identified the provider had not taken immediate steps to prevent the abuse or taken action to ensure the abuse was not repeated.

The Provider had not ensured people were safe because they had not always provided care and support in accordance with people’s individual care plans. People who required two staff to support them with moving and positioning frequently had just one member of staff attend to them, thereby placing people and staff at risk of physical harm.

We found that the provider had not ensured that people had been protected from the risks of unsafe care because people’s needs had not been appropriately assessed and reviewed. Care plans did not contain enough detail to enable staff to meet the individual needs and preferences of people. Where risks had been identified staff did not always deliver care in accordance with the risk assessment management plans to keep people safe.

There were not enough staff deployed to meet peoples’ needs. People we spoke with were frustrated at the high level of missed and mistimed calls. The provider was actively recruiting more staff, although current staff were disillusioned and continuing to leave.

The provider did not have a robust selection and recruitment process and had employed staff without obtaining all of the relevant information to ensure they were suitable to provide care and support to vulnerable people.

People were not supported to have their assessed needs met by staff with the necessary skills and knowledge. People were sometimes supported to mobilise without the correct equipment and advice from health professionals was not always followed.

Most people told us they were able to see other health professionals and that care staff knew about their appointments and supported them with these where required. Staff had recognised changes in people’s needs and raised concerns about their health with relevant health professionals.

Staff obtained consent from people before providing their care, which had been confirmed by people we spoke with or their relatives. However, staff were unable to demonstrate an understanding of the principles of the Mental Capacity Act (MCA), 2005 or describe how they supported people to make decisions where required. People were cared for by staff who had not received relevant training and did not understand their responsibilities in relation to the MCA 2005. The provider could not be assured that staff always obtained valid consent from people.

People were not always supported to have sufficient to eat and drink at the right time. People or their relatives were concerned that the high volume of mistimed calls meant that people often did not wish to eat or drink anything, or were eating at the wrong time. For example people regularly experienced late breakfast calls at lunchtime.

Positive and caring relationships which had been developed with continuity of staff were being undermined by chaotic rostering. People told us that they were asked about their support and were involved in making decisions about their care and treatment. Some people told us they were not always spoken to in an appropriate manner and they were not always respected by the care staff.

People and their relatives told us their care visits, particularly in the morning, promoted their independence for the rest of the day. Missed or mistimed visits had an adverse impact on their independence. People said It was distressing to wait until late morning, often in soiled clothes, waiting to begin their day to day life which made them miserable.

Care plans did not reflect the different needs of each individual. There was no process for reviewing care plans to record people’s changing needs. This meant the provider could not be assured that staff had the correct information and guidance about how to care for people based on their current needs.

The provider did not routinely listen and learn from people’s concerns. Numerous complaints had been made to the local authority because people had become frustrated with the lack of response to their complaints by the provider. Due to these complaints a significant number of people had sought alternative care provision elsewhere.

The registered manager and provider had failed to notify the CQC that they had moved the location of their office. During the first two days of our inspection the service had no internet or telephone connection and communication was being managed on the out of hours duty phone. This meant the provider could not be assured that the service was being run properly and people were receiving care to meet their needs.

People told us the service was poorly managed and lacked leadership. People were disillusioned with the management of the service due to concerns regarding missed and mistimed calls. These concerns were then exacerbated by repeated failure to respond to complaints.

Quality assurance systems were in place but had not been operated effectively, which meant the provider had not identified the concerns discovered during our inspection. Failure to assess and monitor the quality of service meant the provider was unaware of areas that were inadequate and had not taken action to address them.

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.

During the inspection we identified a number of serious concerns about the care, safety and welfare of people who received support from the provider. We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and will report on this when it is completed.