The inspection was carried out on 14, 15 and 21 January 2015. Our inspection was unannounced, which meant the provider did not know we were coming. PCT Diamond Care Services Limited is a domiciliary care service. The office is located in central Dartford. PCT Diamond Care Services Limited provides care and support for approximately 121 people who are living in the community. People receiving care and support were younger adults who had physical disabilities, older people, and some people that were living with dementia. Some people had sensory impairments, limited mobility and some people received care in bed. PCT Diamond Care Services Limited also provided care and support to 26 people living in extra care accommodation called Emily Court.
PCT Diamond Care Services Limited had a registered manager. 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 and associated Regulations about how the service is run.
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 came into force on 1 April 2015. They replaced the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010
. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We are currently taking action against the provider. We will publish an updated report when the action has been completed.
People told us that they felt safe when the staff were providing their care. People told us that they were dissatisfied with the service because staff missed calls to their homes or arrived late without notice. We found that the practices within the service were not always consistent with people’s positive views about their safety.
Staff did not have access to detailed, up to date policies and procedures to enable them to keep people safe from abuse. People were at risk of abuse because staff had not undertaken suitable training in order to recognise and respond to suspected abuse.
There were no accurate up to date records relating to the number of people that received care and support. Some people who received a service did not have their care planned or their needs assessed which meant staff did not have the information they needed to care safely or effectively for them. Risks to people’s safety had not been properly managed. Assessments were not in place to manage the risks associated with storage and use of oxygen, catheter care and epilepsy and other risks associated with the care and support of people.
Staff did not always have guidance and procedures to assist them in their work. There was no procedure in place to detail what staff should do in the event of the death of a person. There had been deaths in the extra care accommodation which had not been managed or reported properly.
Accidents and incidents had been recorded. However, there was no evidence to show that the registered manager or the staff had regularly reviewed and monitored or learned lessons from incidents that had occurred. In one instance the staff had not amended the care plan or produced guidance or risk assessments when a person’s oxygen had not been switched on.
People told us that staff were often late, some people had complained about missed care visits. On the day of our inspection, one relative rang up to complain that no one had been to provide care and support to their family member. The call was made after 09:00. The person was due to have a care visit at 08:00. The staff member that was scheduled to visit the person was off work and no action had been taken to make sure that alternative staffing arrangements were in place. The registered manager had failed to have a system for monitoring how many people required care or how this care would be provided.
Safe recruitment procedures were not always followed. Staff employment files showed that references and full employment histories had not always been checked to make sure the staff employed were suitable to work with people.
The service did not have appropriate arrangements for the recording and safe administration of medicines. Records relating to medicines administered in the community did not detail what medicines people had received.
Staff had not received effective training, support and supervision. Not all staff employed were listed on the training plan. Therefore it was not possible for the manager to monitor the training needs of the team as a whole and ensure courses were arranged in a timely manner in order to meet people’s needs. The training records did not evidence how often staff should update or refresh their training.
Staff had not received regular support, supervision or checks of their competency to carry out their roles.
25 staff out of 48 staff had attended Mental Capacity Act 2005 (MCA) training. Staff showed a lack of understanding with regards to the MCA. This meant that staff had not been trained to ensure people were supported to make decisions in their best interests and how they should recognise if someone was being restricted unlawfully.
Mental capacity assessments did not always follow the principles of the MCA the assessments had not assumed capacity for each person and the assessments were not decision specific. We did not see any evidence that people or their relatives had been involved in mental capacity assessments.
People were not always given choices when they were supported with their meals. One care plan showed that a person needed to drink two to three litres of fluid each day to ensure that they remained healthy. The fluid intake for this person had not been monitored or recorded; therefore the person was at risk of becoming dehydrated and at risk of further health complications. Staff did not always request medical assistance in a timely manner for people whose health needs had changed.
People told us “They never ask me what I would like for breakfast, just put it in front of me. Sometimes they are so late coming they only have time to give me cereal. When my normal carer is away they sometimes do not come at all” and “If I make a complaint they always make excuses”.
People told us, “The carers time is very erratic, especially at the weekend when the bus times alter”; “Wouldn’t rate them very highly, pretty poor really”.
People told us that the staff did call them by their preferred names but we found it was not always possible to know what people’s preferred names were as they had not always been recorded in people’s care plans. People’s care had not been planned for everyone who was receiving care and support. Where care plans were in place they did not contain personalised information for staff to refer to make sure people received the right care for them.
People and /or their relatives had not been asked to be involved in planning their own care or checking that the staff continued to offer the right care and support. Care plans were not in place in some people’s homes which meant staff had no information about these people’s needs. Where care plans were in place they had not been regularly reviewed or monitored to make sure they remained relevant or up to date.
We found that records relating to people were not stored safely and securely. Some records were kept in the office in the filing cabinet; others were stored in bags, boxes and suitcases within the offices.
People told us that they had made complaints and had not received a response. One person had made six complaints, which had not been dealt with effectively. Records showed that investigations had taken place for the complaints recorded, however records did not show how this was then fed back to the complainant. There were no letters of apology to complainants and no way of documenting lessons learned from the complaints.
The service had not carried out a survey to request feedback from people for more than 12 months. People that had made contact with the manager to complain about the service they received did not feel that they had been listened to.
People told us “If I complain or make constructive comments, they do not listen or answer my calls” and “I wouldn’t rate this service good, I suppose one can’t expect too much”. One person said “Even after I have made a complaint the manager does not call to see if all is well”.
The provider did not have arrangements in place to monitor the quality of the service. Medicines administration records (MAR) at Emily Court had not been checked. This meant that errors had occurred but the registered manager had not identified this shortfall or taken action and this put people at risk of not receiving medicines they were prescribed. The manager had not dealt with complaints and incidents relating to staff in a clear and consistent way. Some staff had been suspended for making errors whilst other staff had made the same mistakes but had been allowed to continue working. Their competency to carry out their role had not been checked.
People had not been asked for their views so these had not been taken into account in the way the service was delivered. Staff meetings were held frequently but the minutes did not show how staff had been involved or consulted about the quality of the care or the management of the service.
Records were not accurately maintained. There were gaps in records relating to people and staff. Records relating to incidents were inadequate because they did not always evidence the names of staff involved in the incident and what had been done to prevent the same incidents happening again.
The majority of policies and procedures had not been reviewed and updated since June 2013 to make sure they reflected current research and guidance. Policies and procedures were not fully available to staff working in the community. Therefore, staff were working without proper guidance about the standard of work expected of them or how to manage incidents and care safely.
The provider had not met Care Quality Commissions registration requirements. The provider had not submitted notifications regarding reportable incidents such as safeguarding alerts, deaths and moving premises in a reasonable timescale without prompting by the local authority or CQC.
Staff explained to us how they involved people in their care and support. They detailed that they helped people to choose different clothes to wear and encouraged them to do things for themselves.
Staff had suitable personal protective equipment (PPE). This included gloves, aprons, shoe covers, sleeve covers and antibacterial hand gel.
One person told us, “The care I get from my carers is very good. I am treated with dignity and respect and I wouldn’t change my carers for anything. They are angels and I have had the same ones for 18 months”.
Staff demonstrated respect for people’s dignity. They were discreet in their conversations with one another and with people who were in shared areas of Emily Court.
Staff understood their roles and responsibilities but they did not have access to the organisations policies. The staffing and management structure ensured that staff knew who they were accountable to. The provider had a whistleblowing policy. This included information about how staff should raise concerns and what processes would be followed if they raised an issue about poor practice. Ex staff had informed other agencies including CQC of concerns but not until they had left the employment of the organisation when they were no longer bound by the organisations whistle blowing policy.