18 September 2015
During a routine inspection
This inspection took place on 18 September 2015 and was an announced inspection.
Swanborough Services is a domiciliary home care service offering personal care to approximately 41 people who have neuro-disabilities, or an acquired brain injury (ABI) in their own homes, and also to those living within several supported living environments.
The service is required to have 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 2008 and associated Regulations about how the service is run. At the time of the inspection the service had been without a registered manager for five months. There was an interim manager responsible for the day to day running of the service.
People’s safety was being compromised in a number of areas. Care plans and risk assessments were out of date an did not routinely reflect people’s assessed level of care needs, and some lacked detail to guide staff in keeping people safe. There was no evidence that people were regularly involved in their care planning, or were formally able to give feedback about the service.
Risk assessments, including responding to emergencies and risks to the business, such as business continuity plans were not in place.
There were not enough staff employed to ensure people’s safety and that their needs were met. Feedback from staff was overwhelming that they felt under pressure due to staffing levels. One member of staff told us, “We are short of care staff. We will all work as hard as we can, but it can only be so much. It’s really difficult to cover all the calls. Staff are starting to go off sick now”. The service was in the process of giving notice on several packages of care as they could not ensure that the care could be delivered safely.
Staff rotas were designed for the needs of the service rather than the individual. They contained no provision of travel time for staff to travel between calls, and it was not possible for care workers to get to care visits on time. One member of staff said, “They don’t even consider travel time when they are setting up the rotas, you just have to turn up when you can. We’ll have one call that ends at 7:30am and the next one is scheduled to start at 7:30am and there is no time built in to travel in between. They also don’t factor in the traffic or rush hour”.
Quality monitoring of the service was not robust. Although some informal systems of quality assurance were in place, the service did not carry out any formal systems of quality monitoring, such as audits to assess quality and drive improvements. Policy and procedure documentation was not routinely relevant to the service.
The culture and values of the provider were not embedded into every day care practice. Staff we spoke with did not have a strong understanding of the vision of the service. Feedback from staff was not positive and indicated that there was a lack of cohesion and a negative culture in the service. One member of staff said, “At the moment it’s the most unstable it’s ever been here. I’m not happy in my job”.
Where people lacked mental capacity to make specific decisions, the service was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. However, despite some senior staff having appropriate training and knowledge, we found that care staff had not received formal training around the MCA.
Medicines were managed safely and people received the support they required from staff. There were systems in place to ensure that medicines were administered and reviewed appropriately.
Staff were recruited safely through appropriate recruitment practices, and received an induction, basic training and additional specialist training specific to the needs of people. Staff had group and one to one meetings which were held regularly, in order for them to discuss their role and share any information or concerns.
If needed, people were supported with their food and drink and this was monitored. Where people required assistance from healthcare services, the service acted quickly to ensure the person received the care and support they required.
People and their family members told us they were supported by kind and caring staff. They knew how to raise concerns or complaints and felt they would be listened to and acted upon.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.