Archived: Sanctuary Home Care Ltd - Bromley

We served two warning notices on both the provider and registered manager in respect of the more serious concerns found. We also found breaches of regulation for staff training and because people were not always treated with dignity and respect. The provider sent us an action plan to tell us how they were going to meet these regulations. We will follow up the action taken to address these breaches at our next comprehensive inspection.

This focused inspection took place on 29 and 30 March 2017 and was carried out to check that action had been taken to address the serious concerns regarding medicines, risks to people and the management of the service and ensure the regulations were being met.

Sanctuary Home Care Limited (Bromley) provides personal care at two extra care housing sites, in the Bromley area, in which people live independently in their own tenancies. The personal care service is managed from the registered office at one site. Not everyone at these sites received personal care from Sanctuary Home Care (Bromley). During the inspection we were told there were approximately 110 people who used the personal care service.

The registered manager was no longer working at this location. 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 was being run by an acting manager.

At this inspection we found a breach of regulation in respect of staffing. People told us there were frequently not enough staff. We found this to be the case as there were not always the assessed levels of staff required to meet people’s care needs. We also found that while improvements had been made to the way the service was managed and monitored there remained concerns about the way systems to manage emergencies and some risks were managed. You can see the action we have asked the provider to take at the back of the full version of this report.

We also wrote formally to the provider following the inspection to discuss our findings. They have agreed to send us weekly updates about staffing levels and action they take to address any problems and monthly updates on action to address the other areas identified in this report. We will be monitoring these reports closely.

Improvements had been made to the way medicines were managed and we found these were now managed and administered safely. There were some areas that still needed improvement to ensure this was consistent across the service. Risks to people were identified and assessed although some improvement was needed to ensure this was consistent across the service. Staff had received fire training since the last inspection. The kitchen had people’s up to date dietary needs. The acting manager met regularly with the housing association to try and improve communication.

The rating for the key question Safe remains Requires Improvement and we have changed the rating for Well led from Inadequate to Requires Improvement in line with our characteristics for rating each key question. This has not changed the overall rating which will be reviewed at the next comprehensive inspection.

Sanctuary Home Care Limited – Bromley, provides personal care at two extra care housing sites in the Bromley area in which people live independently in their own tenancies. The personal care service is managed from the registered office at one site. Not everyone at these sites received personal care from Sanctuary Home Care - Bromley. During the inspection the registered manager told us there were approximately 110 people who used the personal care service.

There was a registered manager in post to manage the service across both sites. 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 timing of this inspection was prompted by concerning information we had received about people’s care. Some of this information was the subject of a safeguarding investigation taking place at the time of the inspection. CQC will monitor the outcome of the investigation.

We found serious breaches of regulations in respect of people’s safe care and treatment, the management of medicines and the management of the service. Risks to people were not always identified or assessed; medicines were not safely administered or managed. We had concerns about the poor systems of communication between organisations operating at both sites which did not assure us of people’s safety. Systems to monitor the quality and safety of the services provided, to reduce risks to people’s safety and welfare and to ensure that records relating to service users were always accurate and complete were not effectively operated. Issues we identified had not been identified through the provider’s auditing system. Full information about CQC’s regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We also found breaches in respect of staff training and dignity and respect. Staff training was not always provided to support care workers to meet the full range of people’s needs. We received mixed feedback about the care provided. People at both sites told us a small number of staff were rude and uncaring. Half the people spoke positively about all the care workers and the other half told us some care workers treated them with kindness and consideration but a small number of other care workers did not. You can see the action we have asked the provider to take in respect of these breaches at the back of the full version of this report.

People told us they felt safe at the service but some people at one site told us they did not feel their possessions were always safe. We found that there were sufficient numbers of staff on duty, during the inspection although there had been problems in the previous few months at one site. People told us that fluctuations in their care needs were not always promptly responded to.

Staff received some training and supervision in support of their roles. They were aware of the importance of seeking consent from people when offering them support and told us people had capacity to make decisions about their care. They were aware of their responsibilities under the Mental Capacity Act 2005

People were supported to have enough to eat and drink where this was part of their assessed needs. They were also supported to access healthcare services where required. People were involved in day to day decisions about their care.

People’s needs were assessed and care provided in line with their individual needs and preferences. People were supported to attend the activities provided by another service or to attend day centres where this was part of their support needs. The provider had a complaints procedure in place and written complaints were responded in line with the policy. Some people told us they knew how to raise concerns and had confidence that any issues they raised would be dealt with. Other people told us that when they complained some individual care workers had reacted badly.

There was mixed feedback about the running of the service. Some people said the service worked well and was responsive to their needs. Other people told us it was not well run and that any problems were not effectively managed. There were systems to gather people’s views about the service to improve quality but some aspects of this system made it difficult to establish learning for individual sites or services.