30 October 2017
During a routine inspection
The service provides care to people in their own homes, most people lived in supported accommodation although some people lived alone or with their families in the community. At the time of our inspection they were providing care to 78 people.
The service did not 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.
The provider had failed to consistently improve the quality of risk assessments and medicines management within the service. People remained at risk of unsafe care as risk assessments lacked detail and did not give staff clear information about what they needed to do to mitigate risks. Information about people’s medicines was not always up to date and staff did not have enough information about people’s medicines to support them in a safe way.
Since our last inspection in March 2017 people had been involved in reviewing and updating their care plans. Although some had a better level of information about people’s needs and preferences, others lacked detail. Where people’s needs had changed since they had been assessed care plans had not been updated and this meant staff were providing support without clear written guidance about how to do so. Care plans contained insufficient information about people’s healthcare needs and dietary preferences. Staff did not have the information they needed to ensure people’s healthcare needs were met, or their dietary preferences respected.
Staff told us they did not have to rush, and that they thought there were enough staff to meet people’s needs. The provider had not recruited any staff since our last inspection but had completed checks to ensure the staff they were employing were suitable to work with people.
The service escalated concerns about people being abused or neglected and staff had received training about safeguarding adults from harm. However, the provider did not always take action in a timely manner when staff were alleged to have neglected people.
Where people had capacity to consent to their care, this was clearly recorded. However, where people were not able to consent to their care, records were not clear that the principles of the Mental Capacity Act 2005 had been followed.
Staff had received supervision in line with the provider’s policy. However, they had not received the training they needed to perform their roles. The provider had identified they needed to make adjustments to how they delivered training to facilitate staff understanding.
The provider had taken action to improve staff understanding of how people’s sexual orientation may affect their experience of accessing and receiving care services. However, staff understanding remained mixed.
Some people told us the staff were kind, but others felt they did not demonstrate a compassionate attitude. Although some staff demonstrated an understanding of the importance of knowing about people’s pasts and culture to form relationships, other staff told us they did not think this information was relevant.
The provider had improved how it responded to concerns and complaints. They had taken action where people and relatives had raised concerns about the service and had made the complaints policy available in alternative languages. However, some people remained unsure of how to make complaints.
The provider had taken steps to improve the deployment and scheduling of staff. However, the systems in place were not yet effective in ensuring people received their care as scheduled.
The provider’s quality assurance and audit systems had identified some, but not all, of the issues we found on the inspection. However, the provider did not follow up on whether the required actions had been taken. The systems in place had not been effective in identifying and addressing issues with the quality and the safety of the service.
The provider had not submitted notifications to us as they are required to do.
We identified continued breaches of six regulations regarding person centre care, consent, safe care and treatment, staffing, good governance and the requirement to submit notifications. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
The overall rating for this service remains ‘Inadequate’ and the service therefore remains 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.
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.