Background to this inspection
Updated
16 November 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We gave the service 19 hours’ notice of the inspection. This was because we wanted people’s permission to talk to them before we telephoned them. The inspection started on 21st August 2018 and ended on 22 August 2018.
The inspection team consisted of one inspector.
Before the inspection we had been in contact with the local authorities’ contracts team to ask them for their views on the service. They had concerns about the care people received and how the service was being managed. We looked at the notifications that the registered manager had sent us over the last year. Notifications are about important events that the provider must send us by law.
Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection we spoke with seven people who used this service, and five people’s relatives. We also spoke with five members of staff, the office manager and the registered manager. We looked at the care records of five people, the medicines records of four people and the recruitment records for three members of staff. During our visit we also reviewed the systems and documents available to monitor the quality of the service.
Updated
16 November 2018
Special Seven 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 adults.
The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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.
Not everyone using Special Seven receives a regulated activity; the Care Quality Commission (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.
At the time of this inspection Special Seven were supporting 24 people.
There was a registered manager in place. 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.
We carried out a comprehensive inspection of this service on 22 August 2018. We had inspected Special Seven in March 2017 and then again in December 2017. This was following concerns raised about the quality of care which people were receiving. At that inspection the service was rated as Requires Improvement overall with a rating of Inadequate in safe. The overall rating for this service at this inspection is ‘Requires Improvement’ with Inadequate in well led.
We found that safe staff recruitment processes were not being adhered to. We also found this at the last inspection, but despite some improvements being made, we still found short falls in this area. Two members of staff did not have up to date disclosure and baring service checks in place. Staff did not have full employment histories. Some staff only had one reference and there was no evidence that second references had been followed up.
A concern about a person’s safety had been raised by the service. However, this had not been processed in a safe way with the local authority. There were short falls in staff’s knowledge about how to protect people from experiencing abuse and discrimination.
We found that people’s risk assessments were not always complete. Some of the risks which people faced daily had not been identified and explored at people’s assessments. The accompanying care plans did not fully outline the support people needed to ensure people were safe.
People were not always being supported to receive their medicines in a safe way. The checks the management of the service completed about this were not always effective. We also found examples when the service did not promote people’s physical health and respond to situations when people were or could be unwell.
The service was not compliant with the Mental Capacity Act 2005 (MCA). Consent to care and to share personal information with other individuals and organisations was not always fully obtained. Relatives who did not have the legal powers to do so, consented on their relative’s behalf to agree to care. Although people said staff asked for their permission to support them with personal care tasks, the management of the service were not fully promoting people’s rights in this area. The service had assessed people’s capacity to make decisions, but these assessments were not complete.
When something went wrong lessons were not always taken from these situations. The leadership did not consider what went wrong, and what they could do to try and prevent a similar situation from happening again.
The management and the provider of the service were not completing robust and meaningful audits to test the quality of the service provided. When some records were being audited key issues with these documents were not identified and investigated further.
The management team and the provider had not responded to potential concerns about the culture of the staff team. Systems were not in place to ensure poor practices did not happen again.
The management of the service were not sharing certain events which they must do by law, with us at the Care Quality Commission (CQC) or displaying their rating from the last inspection.
The management of the service did not have a clear knowledge of the most vulnerable people the service supported. They did not have a robust emergency contingency plan in place.
We found that there were gaps in staff’s knowledge and understanding of certain areas important to their work. The training provided did not reflect all of people’s needs and how to support them
We had some mixed responses when we asked people if they found staff kind and caring towards them. Most people said that staff were kind and caring, but some people had commented that some members of staff were not kind to them. When this was identified or inferred at people’s reviews, these comments were not investigated further.
These issues constituted breaches in the legal requirements. There were six breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
People and their relatives spoke positively about how the service and the management of the service had improved since last December. People now told us that they received care visits when they generally wanted them to take place. They also confirmed to us that they saw a regular group of staff who they felt knew them well.