Archived: De Vere Care - Ealing

The last inspection took place in January 2018. The service was rated requires improvement overall, and in the key questions of ‘Is the service Safe, Effective, Responsive and Well Led?’. The key question of “Is the service Caring” was rated good. We found five breaches of regulations relating to consent to care and treatment, safe care and treatment, receiving and acting on complaints, good governance and staffing. We served warning notices on the provider in relation to complaints, good governance and staffing. We asked the provider to make the necessary improvements by 10 March 2018. At this inspection we found the provider had not made sufficient improvements and had not been able to fully meet the regulations. In addition, we found two further breaches of regulations.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, some living with the experience of dementia, people with learning disabilities and people with mental health needs. People’s care was funded by the local authority or privately. At the time of our inspection twenty people were using the service. Not everyone using De Vere Care received the regulated activity of personal care; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had a registered manager, but they were on long term leave and the provider had not made arrangements for an interim 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.

During the inspection we found that risk assessments and risk management plans were not always robust enough to minimise risks to people and others. This meant the provider was not assessing, monitoring and mitigating risks to people to help minimise their exposure to the risk of harm. Incidents and accidents were not always recorded, for example, when care workers missed calls. This meant the provider was not always acting to minimise risks to peoples’ safety and well being

Medicines management was inconsistent including care workers not recording when they supported people to take their medicines and the failure to use medicines administration records (MAR) to record the administration of prescribed topical creams. In addition, the medicines policy had not been appropriately updated to provide effective guidance and the audits did not always identify discrepancies to help ensure people always received their medicines in a safe way. Furthermore, not all care workers had up to date medicines training or medicines competency testing to make sure they could support people with their medicines safely.

Safe recruitment procedures were not always followed to ensure care workers were suitable to work with people. Training, supervisions and appraisals were not up to date which meant care workers did not always receive the support they required to develop their professional skills and knowledge.

Where people lacked the mental capacity to consent to specific decisions, the provider did not always follow the principles of the Mental Capacity Act 2005 (MCA). Nor did care workers have a good understanding of the MCA.

Care workers were not always adequately deployed to ensure that calls took place and that care workers stayed the length of time as planned and agreed with people using the service.

The monitoring officer and the care co-ordinator were available to care workers and listened to their concerns and tried to address these. However, we saw complaints were not always being recorded, investigated and followed up in a timely manner and care workers were not made accountable for their actions that resulted in a complaint.

Care plans were not always robust or detailed enough in their guidance and in some cases, were not person centred.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, these were not always effective because of the lack of improvements and to an extent to the deterioration in the quality of the service since our last inspection.

The provider had an infection control policy in place but not all staff had undertaken training in this area to help protect people against the risks of the spread of infection.

We saw there were procedures for reporting and investigating allegations of abuse and whistle blowing. Staff we spoke with knew how to respond to safeguarding concerns.

People’s nutritional needs and dietary requirements were assessed and care workers knew how to support people to maintain good health.

People’s needs had been assessed prior to starting with the service and care plans included people’s likes and dislikes. However, people and their families were not consulted about end of life care.

We found seven breaches of regulations in relation to person-centred care, fit and proper persons employed, consent to care and treatment, safe care and treatment, receiving and acting on complaints, good governance and staffing. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The last inspection took place in April 2017 and the service was rated ‘requires improvement’ in Safe, Effective, Responsive, Well Led and overall. Caring was rated ‘good’. We found breaches of Regulations relating to person centred care, safe care and treatment, receiving and acting on complaints, good governance, fit and proper persons employed and staffing. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well Led to at least a ‘good’ rating. During this inspection, we found that some improvements had been made but not enough to meet all the regulations.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people, people with learning disabilities. physical disabilities and mental health needs. At the time of the inspection, 22 people were receiving a service for a regulated activity. Not everyone using De Vere Care Ealing received a regulated activity. CQC only inspected the service being received by people provided with 'personal care'.

The service had a registered manager who also managed other locations for the provider and was based at the head office. They were not present during the inspection and we spoke with the branch manager who had made an application to the Care Quality Commission to become the 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.

During the inspection on 9 January 2018, we saw safe medicines procedures were not always followed. The medicines training for staff and assessments of their competency to manage medicines were not up to date.

Care workers received an induction and supervision but did not have up to date appraisals, spot checks or training to ensure they had the skills and knowledge to deliver effective care and support.

Consent to care was not always sought in line with the principles of the Mental Capacity Act 2005 (MCA)

There was not always evidence of complaints being recorded, investigated and followed up in a timely manner.

The provider had a number of data management and audit systems in place to monitor the quality of the care provided. However records were not monitored effectively to ensure there were no gaps in the required information.

There was a procedure in place for the management of incidents and accidents which were recorded in people’s files but not logged at a single point to provide an overview of the concerns. Risk assessments were up to date and reviewed but they were not all relevant as some people were assessed to be at high risk when they were not. For example a mobile person being assessed as at high risk of pressure sores.

Safe recruitment procedures were followed to ensure care workers were suitable to work with people using the service and care workers knew how to respond to safeguarding concerns to help ensure people received care safely.

The provider had an infection control policy in place but not all staff had undertaken training in this area to help protect people against the risks of the spread of infection.

People’s nutritional needs and dietary requirements were assessed and care workers knew how to support people to maintain good health.

Care plans identified people’s needs and preferences and provided care workers with guidelines to effectively care for people in a way that met their needs. They were reviewed annually. People said care workers treated them kindly and with respect.

People and their families were involved in planning people’s care but were not consulted about end of life care.

The manager and the care co-ordinators were available to people and care workers and listened to concerns.

We found five breaches of regulations during the inspection. These were in respect of safe care and treatment, receiving and acting on complaints, staffing, the need for consent and good governance.

We are taking action against the provider for failing to meet regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service registered with the Care Quality Commission (CQC) on 21 October 2015 and this was their first inspection.

De Vere Care (Ealing) is a domiciliary care agency that provides personal care to people in their own homes in the London Borough of Ealing. The service was originally set up to provide care to children. In 2015, the organisation expanded to include care for adults. Both services are managed through the same management team. At the time of the inspection, the service was supporting 20 adults.

The service did not have a registered manager. The last registered manager left in August 2016. Another manager was employed but they left in January 2017 before registering. The contracts manager told us the service was currently in the process of recruiting a new manager who would apply to register with the Care Quality Commission. 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.

The service did not always follow safe recruitment procedures, as the provider did not always obtain the required information about the staff. This meant there was a risk that the staff were not suitable.

Neither medicines refresher training nor medicines competency testing had been carried out in 2016. One person who had specific needs around medicines did not have guidance for staff on how to administer them safely. Therefore, we could not be sure medicines were being administered correctly.

Care workers last had supervision in August 2016, had not had appraisals in the last year and the files we viewed did not have a record of any spot checks undertaken in 2016 or 2017. This meant staff did not receive the necessary support to undertake their roles competently.

Where people did not have the capacity to make decisions, mental capacity assessments had not always been undertaken or a Legal Power of Attorney identified. Staff we spoke with had little or no understanding of the requirements of the Mental Capacity Act 2005. We recommended that consent is sought for care and treatment and where a person lacks mental capacity, the provider acts in accordance with the requirements of the Mental Capacity Act 2005.

The service had an electronic rota systems that recorded when care workers began and completed their calls. We saw from the call logs, complaints and feedback that care workers did not always complete their calls in accordance with the planned times and that there was no analysis of the calls to improve service delivery.

The service had a complaints policy and we saw complaints were recorded and an outcome written up. However, outcomes were not always followed up.

Audits were not always completed or consistently carried out. Staff file audits were not completed and the care worker competency check list had not yet been implemented. The service said Medicines Administration Records (MAR) were being audited but this was not effective as we saw missed signatures on a MAR chart that had not been identified by the provider.

There was a sufficient amount of staff. Care workers had comprehensive training as part of their induction, had attended safeguarding training and knew how to respond to incidents.

People using the service and their relatives said care workers were kind and helpful and that there was positive communication between themselves and the care workers. People said they were able to make choices and were involved in their day-to-day care decisions.

Each person using the service had been assessed for a number of risks and a risk management plan had been completed to minimise the risk. The assessment plans indicated people or their relatives were involved in their assessments, care plans and reviews.

People were asked for their views and we saw evidence of telephone monitoring. The service had a complaints procedure and people told us they knew how to make a complaint.

People’s health needs were recorded in their care plan and the care plans included a section on eating and drinking and what support people might require in this area.

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