Archived: Westminster Homecare - Sheffield

At our last inspection on 29 March and 3 April 2017, we found continued breaches in four regulations of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014: Regulation 9, Person-centred care, Regulation 12, Safe care and treatment, Regulation 13, Safeguarding service users from abuse and improper treatment and Regulation 17, Good governance. We also found an additional breach in Regulation 16, Receiving and acting on complaints. We issued warning notices for regulations 9, 12 and 17 and requirement notices for regulations 13 and 16.

Following our last inspection, we met with the registered provider to confirm what they would do and by to make improvements at the service.

This inspection was undertaken to check that the service had made improvements and to confirm that they now met all of the legal requirements. At this inspection, we found sufficient improvements had not been made to meet all those legal requirements.

There was a manager registered with the Care Quality Commission for the service. 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. This was a different manager than at the last inspection.

We found some improvements in responding, recording and taking action to minimise risk. However, further improvement was required, so that all people were supported to stay safe and have their nutritional and healthcare needs met.

We found some improvements in the systems and processes in place to support the safe management of medicines, so that concerns with medicines were being identified and action taken to minimise further concerns. However, further improvement was required so that the proper and safe management of medicines was in place for all people.

We continued to receive mixed views regarding consistency of staff, call times and the length of calls.

The service had a process in place to listen and respond to people’s concerns and complaints. Improvement was required to resolve the root cause of the complaint to minimise the risk of reoccurring complaints.

We found improvements to the systems and processes the service used to monitor risks and people’s satisfaction at the service, and compliance with regulations. Whilst these showed improvements, further improvement was necessary to ensure compliance with regulations.

Systems and processes were in place to protect people from abuse and avoidable harm, including the management of financial transactions.

When staff were recruited, a system was in place so that the relevant information and documents were obtained. The service had systems and processes in place to provide training, supervision and appraisal for staff so that they had the skills, knowledge and experience to deliver effective care and support.

People were treated with compassion, kindness, dignity and respect.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, improving records and staff knowledge in the subject of MCA would better evidence this.

The inspection found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At the last inspection on 10, 11 and 17 August 2016 we found breaches in four regulations of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014: Regulation 9, Person-centred care, Regulation 12, Safe care and treatment, Regulation 13, Safeguarding service users from abuse and improper treatment and Regulation 17, Good governance. Following that inspection, the registered provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan and to confirm that they now met all of the legal requirements. At this inspection we found sufficient improvements had not been made to meet those legal requirements. We found continued breaches in Regulations 9, 12, 13, and 17. We also found an additional breach in Regulation 16, Receiving and acting on complaints. This showed the registered provider had not monitored progress against plans to improve the quality and safety of the service, and had not taken appropriate action without delay where progress was not achieved as expected.

There was a manager registered with the Care Quality Commission for the service. 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.

At this inspection we found there were not appropriate arrangements in place to manage medicines to ensure people were protected from the risks associated with medicines. The registered provider was in the process of providing medication refresher training and medication supervision to all their staff. This had been at the request of the local authority due to the nature and number of concerns they had received involving medicines.

At this inspection we found the systems in place to manage and support people with their monies were not robust and did not safeguard people from financial abuse.

We were not confident that the systems and process in place to prevent abuse of people using the service were being operated effectively at the service.

We received mixed views from people about the quality of care they had received; some people were fully, partially or not satisfied at all with the quality of care they had received.

People were supported with their health and dietary needs, where this was part of their plan of care.

At this inspection we saw some people’s care plans had not been regularly reviewed or responsively when their needs had changed. We found the registered provider had still not ensured that all the people who used the service received person centred care that was appropriate, met their needs and reflected their personal preferences, whatever they might be.

At this inspection we found the scheduling and delivery of care calls required improvement to enable all people who used the service to experience continuity of care. We found the registered provider had not taken appropriate action without delay where progress was not achieved as expected.

We found the registered provider did not have robust processes in place to enable them to respond to people and/or their representative’s concerns, investigate them and take robust action to address their concerns.

We found the registered provider had failed to ensure there was an accurate, complete and contemporaneous record in respect of each person who used the service.

We found sufficient improvement had not been made to ensure there were robust systems and processes in place to assess, monitor and improve the quality and safety of the services provided.

Staff we spoke with made positive comments about the induction training they had received when they started working at the service.

We saw the systems in place to address concerns with individual staff performance required improvement.

There were recruitment processes in place. One staff member’s recruitment records showed the registered manager had not adhered to the registered provider’s policy and procedures. We shared this information with the director of operations.

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.

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.

This was first time this service has been inspected by the Care Quality Commission. The service was registered with the Care Quality Commission on the 19 October 2014.

Most of the people we spoke with felt “safe” and this feedback was reflected in the questionnaires we received. A few people told us they did not feel “as safe” when they were being supported by staff they had never met before.

We found the systems in place to manage and support people with their monies were not robust and did not safeguard people from financial abuse.

Most people who received support from regular workers for all or most of their care package were satisfied with the quality of care they had received. However, some people did express concerns about late calls being delivered.

People who did not have regular care workers told us they wanted to be supported by regular care workers and not to experience late calls.

We received mixed views from relatives regarding the quality of care their family member had received. Some made positive comments about the care their family member had received whilst others made negative comments.

Individual risk assessments were completed for people so that identifiable risks were managed but these were not being regularly reviewed to ensure they reflected people’s changing needs.

We found the provider had not ensured there were appropriate arrangements in place to manage medicines to ensure people were protected from the risks associated with medicines.

There were robust recruitment processes in place. This told us people were cared for by staff who had been assessed as suitable to work at the service.

Staff received training and ongoing support to enable them to support people appropriately.

The feedback we received from people, relatives and the review of people’s records told us the scheduling and delivery of care calls required improvement to enable all the people using the service to experience continuity of care.

We received mixed views from people regarding the staff. For example, some people made very positive comments about the staff in particular their regular workers and said they were caring. Some people told us that some staff did not communicate well and did not speak whilst delivering calls.

We found people’s care plans had not been reviewed regularly. We found the provider had not ensured that people using the service received person centre care that was appropriate, met their needs and reflected their personal preferences, whatever they might be.

We found the service had a robust process in place to enable them to respond to people and/or their representative’s concerns, investigate them and had taken action to address their concerns.

Accidents and untoward occurrences were monitored by the registered manager and operations manager to ensure any trends were identified.

We found the provider’s systems and processes to assess and monitor the service had been ineffective in practice.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were a breach of Regulation 9, Regulation 12, Regulation 13 and Regulation 17.

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