Archived: Rapid Response Home Care

Updated 26 April 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 was planned to check 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.

This inspection took place on 31 July and 1 August 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We wanted to arrange home visits and telephone calls to people who used the service and to ensure staff were available to speak with us. The inspection was carried out by one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We had received information of concern from the local authority and people who used the service that calls were being missed and people’s specialist needs were not being met. We reviewed statutory notifications the provider had sent us about important events that occurred in the service and spoke with commissions who arrange services on behalf of people. We used all this information to formulate our inspection plan.

On this occasion, we had not asked the provider to submit a provider information return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. However, we gave the provider the opportunity to share information they felt was relevant with us.

We visited three people who used the service and their relatives. We also telephoned 11 people who used the service and their relatives. We spoke with the provider, the training manager and five care staff. We reviewed records held at the service’s office, which included seven people’s care records to see how their care and treatment was planned and delivered. We reviewed staff files to see how staff were recruited, trained and supported to deliver care appropriate to meet each person’s needs. We looked at the systems the provider had in place to ensure the quality of the service was continuously monitored and reviewed to drive improvement.

Updated 26 April 2018

We inspected this service on 31 July and 1 August. This was an announced inspection and we telephoned 48 hours’ prior to our inspection in order to arrange home visits and telephone calls with people who use the service.

Rapid Response Medical provides personal care and support to people living in their own homes in Stafford and the surrounding areas, Staffordshire Moorlands and Telford. The provider also operates an ambulance transport service from this location. This inspection visit relates to the personal care and support service only. At the time of our visit, 67 people were receiving a service.

There was no registered manager for the personal care and support service. 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 recently recruited a manager who was working their second week at the service. They told us they would be applying to register with us.

We found several breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the service was not safe, effective, caring, responsive or well led. The overall rating for this service is Inadequate which means it will be placed into 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.

There were insufficient staff available to ensure people received timely support. People told us their calls were often late or rushed and staff did not have sufficient time to get between calls. Staff did not always feel they were listened to and were concerned that staff morale was low due to high staff turnover. Staff did not always receive effective training and support to fulfil their role.

People's medicines were not always managed safely. The provider did not have effective systems to continually assess, monitor and improve the quality and safety of the service. They relied on their electronic care management system which was not always effective and did not have any additional checks to ensure people received their planned care. The provider had acted on feedback received from people about their care. However, they had not monitored the improvements made to check that they had not been effective. Complaints made to us showed that people were still receiving a poor quality service. The provider did not always meet their responsibility to notify us promptly of important events that occurred in the service.

Staff did not always follow the legal requirements when people lacked the capacity to make certain decisions. However, staff understood the importance of gaining consent where people had capacity to make their own decisions.

People had good relationships with the staff that supported them on a regular basis. However, the lack of available staff meant that people did not always know who would be visiting them and they did not always feel respected by these staff. Some people’s preferences for their choice of who provided their care were not always met. Staff were not always able to support people in a timely way to ensure they were engaged in activities that promoted social inclusion.

Risks associated with people’s care and home environment were assessed and managed. Staff understood their responsibilities to protect people from the risk of abuse and were confident any concerns reported to the provider would be acted on. However, some staff were unsure of how to escalate concerns to the local authority safeguarding team if they needed to. The provider followed recruitment procedures to ensure staff were suitable to work in a caring environment.

People's privacy and dignity was promoted and staff encouraged them to be as independent as they wished. People managed their own healthcare needs but staff supported them to access other health professionals if required. Where needed, people were supported to have sufficient amounts to eat and drink.

People did not feel their concerns and complaints were listened to and acted on. People did not always feel they were supported to have a care plan that reflected their agreed support needs.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.