Archived: Mrs Rudo Gray

When we inspected the service on 07 July 2014 we found that people were not always cared for, and supported by, suitably qualified, skilled and experienced staff. At our inspection on 25 September 2014 we found that improvements had been made in this area and that there were now effective recruitment systems in place incorporating criminal record checks and references.

People who used the service and the relatives we spoke with all told us that they liked the staff but that there was no consistency. There was a high turnover of staff and there was often little or no notice given of when new staff members would arrive at people's homes to provide care and support. People told us that this sometimes made them feel unsafe. For example, one family member told us, 'I feel she (the provider) is scrambling to find cover as there is a big turnover of staff.' They went on to say, 'It is stressful for [my relative] having new faces in their house all the time. She (The provider) does seem to pick good carers but they do not seem to stay, there is no consistency. There is clearly a lack of staff.'

Health professionals and relatives of people who used the service told us that there were sometimes communication difficulties with staff members whose first language was not English.

Up to date information and guidance about safeguarding matters was not always available for people who used the service, staff members or families of people who used the service.

Staff members we spoke with confirmed that they had undertaken all the necessary training, such as moving and handling, medication, infection control, health and safety, food hygiene and safeguarding vulnerable adults. Staff members we spoke with confirmed that they received one-to-one supervision sessions with the provider and as part of these sessions they felt able to discuss any areas of their work.

At our inspection on the 31 January and on the 03 and 06 February 2014 and a further inspection on the 13, 2, 28 March and on the 14 April 2014, we found that the service was not meeting standards in relation to the care and welfare of the people, safeguarding the people who use the service, requirements in relating to workers, staffing, assessing and monitoring the quality of service provision and complaints.

During this inspection we set out to find if the home was now meeting those outcomes. We also set out to answer our five key questions; Is the service caring, responsive, safe, effective and well led?

The inspection was carried out by two inspectors over two days.

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people were protected from abuse and avoidable harm.

We found that service had made improvements to their recruitment process and that only people who were suited to care for vulnerable people were employed. People were protected from the risk of harm by ensuring staff were trained to recognise and act on the signs of abuse. Risk assessments had been carried out and care plans updated to reflect people's personalised care needs. Staff who worked at the service were aware of people's individual needs and how to keep people safe. However, we did find some minor gaps in the recruitment process pertaining to established staff.

The service is in the Local Authorities serious concerns process. No new concerns had been identified.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes

and promoted a good quality of life which was evidence-based where possible. We reviewed the care and support plans for four people who used the service. We found that the care plans had been reviewed and now contained appropriate person centred information to inform care staff how to support people in an individualised manner. We saw that the service had now included the person or their representative in care planning.

Is the service caring?

By caring, we mean that staff treated people with compassion and kindness.

We were told by people who used the service that the staff who deliver their care were kind and caring. One family told us that the care staff were considered extended family members.

Is the service responsive?

By responsive, we mean that services were organised so that they met people's needs. At our inspection on the 31 January and on the 03 and 06 February 2014 and a further inspection on the 13, 2, 28 March and on the 14 April 2014, we found that the service was not meeting this standard. During this inspection we found that improvements had been made and now there was enough appropriately trained staff to meet the needs of the people.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation

assured the delivery of high-quality person-centred care. At our inspection on the 31 January and on the 03 and 06 February 2014 and a further inspection on the 13, 2, 28 March and on the 14 April 2014, we found that the service was not meeting this standard.

During this inspection we found that improvements had been made and that the service now had systems in place to ensure that all aspects of care delivery was planned and reviewed in an appropriate manner. People were now included on service delivery and there were systems in place to capture and respond to feedback

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

We found that the service was not meeting the areas we inspected.

If you wish to see the evidence supporting our summary please read the full report.

You can see our judgements on the front page of this report.

Is the service caring?

We found that while some of the care staff were found to be kind and caring we found that care planning was not always conducted in a manner that included the person or their relatives. We found that the care of the people was sometimes secondary to new business for the agency.

We found that where concerns were raised by the people who used the service they were not always responded to. There were not sufficient staff on duty to ensure that the staff had time to spend with the people to ensure their care was person centred and delivered in a manner that promoted their dignity.

Is the service responsive?

We were told by the people who used the service that when their main carer was on duty that staff members endeavoured to meet their needs in a safe manner. However, staff were frequently late or a new staff member could be sent without instructions on how to care for the person.

Is the service safe?

We saw care plans were not personalised and did not reflect the needs of the people who used the service. People we visited in their own homes did not have any potential risk to them assessed and addressed appropriately. Care plans were changed without the agreement of the person or their relative. Staff were not given direction on how to deliver care safely. We saw that people were left at risk of neglect as their full time carer (live in providing 24 hour care) was taken away from them to provide care for another person. The agency did not follow a robust recruitment procedure that would have protected the people.

Is the service effective?

Discussions with people who used the service and a review of care plans showed that the service was not well planned and there was not enough staff to meet the people's needs.

Is the service well led?

Following our last inspection visit on the 31 January 2014 we issued two warning notices. These were issued on the 18 February 2014, We did this because we were so concerned about the care of the people who used the service. We visited on this occasion to check if the agency had met the requirements we left. We found that while some improvements had been made we still had concerns about how the agency was run. Staff were providing care to the people before they had carried out their mandatory training. Information we needed to complete our inspection was not available. An audit that had identified poor moving and handling practices that could have put the person at risk of injury or discomfort had not been acted on and addressed.

We found that the service did not have an up to date list of people using the service, or of the staff employed. The care plans we saw did not contain appropriate guidance for carers to be able to meet people's needs and lacked robust risk assessments. The service did not have robust systems in place for safeguarding people from harm. The service had not carried out thorough checks on the people it employed to work unsupervised in people's own homes. The service did not have systems in place to monitor and respond to late or missed visits and was not able to demonstrate that all staff had sufficient skills and training to be able to meet people's needs. There was not a robust quality assurance system in place and the way the service responded to concerns and complaints was not effective.

During our inspection in November 2012 we had found that people's care plans did not always accurately reflect their personal needs and healthcare requirements. This lack of information had exposed people to the risk of receiving inappropriate care and treatment. We further noted that not all the documents and records were kept securely in the administrative office.

During this follow-up inspection, we found that the provider was meeting these essential standards of quality and safety.

During our inspection, we found that the provider was non compliant with two of the outcomes inspected. The provider said that actions had been taken to employ two part-time administrative staff to assist with record keeping, and work was in progress to update all the care plans.