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Pannonia Care Requires improvement

Reports


Inspection carried out on 2 April 2019

During a routine inspection

About the service: Pannonia Care is a small domiciliary care agency providing care to people in their own homes. They provide care to people living with dementia, a learning disability or a medical condition. Pannonia Care can offer a live-in or live-out service. At the time of our inspection, nine people were receiving care from the agency. Of those, five people had live-in carers.

People’s experience of using this service:

People’s care records were more detailed than we had found at our last inspection in September 2018. However, there was further work to be done by the registered manager to ensure documentation in relation to risks to people and medicines administration were robust.

People told us their consent was sought and they could make their own decisions about their care. They told us they were cared for by staff who showed them respect and who were kind and caring.

People could choose what they wanted to eat and said staff were good at ensuring they had the medicines they needed or medical intervention provided when needed.

People said the registered manager was good and we saw evidence that people’s feedback was sought on the quality of the care they received.

People said they saw staff washing their hands and they felt confident that staff were trained well. They told us they felt safe with staff and that staff knew them and their care needs well. People said they had not had a reason to complain.

The registered manager had recruited an assistant since our last inspection who had helped them drive improvement by developing processes and procedures and introducing new audits. There had been a marked improvement in the agency overall and the registered manager had realised their need to take better management oversight.

Improvements we found need to be embedded now in to daily practice and the remaining shortfalls addressed, although risks to people’s safety was mitigated due to how well staff knew people and because most people had live-in carers.

During the inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made two recommendations to the registered provider. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: We last inspected Pannonia Care on 14 September 2018. We rated the service at that time as Inadequate and we took enforcement action against the registered provider and placed them in special measures. The report was published in October 2018.

Why we inspected: We carried out this fully comprehensive inspection to check the registered provider had taken the required action to help ensure that people were receiving safe, effective and responsive care and that they were meeting the required Regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Enforcement: We issued warning notices at our last inspection which gave the registered provider a fixed timeframe in which to take action to ensure they were meeting the regulations.

Follow up: We will carry out future inspections to Pannonia Care in line with our published inspection methodology.

Inspection carried out on 14 September 2018

During a routine inspection

Pannonia Care provides care and support to people in their own homes. There were 12 people using the agency at the time of our inspection. Of those 12 people six received live-in care.

This announced inspection took place on 14 September 2018.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the agency. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the agency is run. The registered manager assisted us with our inspection.

We last inspected this agency in September 2017 where we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person-centred care, safe care, training and supervision and consent and governance. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 as the registered manager had failed to notify us of significant events that had taken place in the agency. Following that inspection, the registered manager provided us with an action plan on how they were going to address these shortfalls. We carried out this inspection to check that action had been taken in line with their plan. We found a small improvement in some areas, but continued shortfalls overall within the agency.

People’s medicines were not managed in a safe way and staff did not follow best practice in relation to records, pain patches and topical creams. Some people did not have care plans in place which meant risks to these people may not have been considered. There was a lack of robust oversight of accidents and incidents and information relating to these were not held appropriately.

Although people’s needs were assessed before they received care from the agency, information in these assessments was not always transferred into care plans. Staff did not follow the principals of the Mental Capacity Act 2005 as people’s consent was not sought when restrictive practices were being carried out.

Staff did not receive the training or supervision they should have and some staff had not been recruited through robust recruitment systems. Systems were not in place to audit or quality assure the care that was being provided by the agency. The registered manager did not have a commitment to improve the service as they failed to act on shortfalls identified at our last inspection. There was a lack of progress since that inspection to improve the paperwork or systems at the agency.

People told us they were cared for by staff who were kind and caring, showed them respect and allowed them to make their own choices. Where people wished to participate in activities outside of their home staff supported them to do this. When people needed healthcare treatment this was arranged for them by staff.

People were cared for by staff who understood their responsibilities in helping to ensure infections were not transferred. People told us that staff arrived on time and stayed the time they expected and staff felt there was enough of them to provide the care that was needed. People knew how to make a complaint but told us they had never felt the need to and that if they wished to change their care or increase their visits this was usually accommodated. The agency worked with the local authority in relation to safeguarding incidents and staff understood their role.

During our inspection we found five continued breaches and one new breach 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. 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.

The overall rating for this service is ‘Inadequate’ and the service has therefore been placed 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.

Inspection carried out on 1 September 2017

During a routine inspection

This inspection was carried out on 1 and 4 September 2017 and was announced. Pannonia Care provides personal care and support for people in their own homes. This includes people that are old and frail and people that have disabilities. The service provides day care and live in care. At the time of our inspection the service provided personal care to 11 people.

There was a registered manager in post and present at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks to people were not always assessed in order to keep them safe from harm. Staff were not keeping a record of what medicines people were being given and there was guidance missing for as and when medicines.

The provider had not ensured that all new staff were thoroughly checked to make sure they were suitable to work for the service. We have made a recommendation around this.

People told us that they felt safe with staff and staff understood what to do if they suspected any form of abuse.

Staff had not always received appropriate training and supervision in relation to their role. Inductions for staff were not always taking place. Other mandatory training was provided to some staff.

There was a risk that people’s rights were not protected because staff did not act in accordance with the Mental Capacity Act 2005 (MCA). Where people’s capacity was in question MCA assessments were not taking place.

Care plans were not always personalised and did not always have detailed guidance for staff specific to each person needs. Assessments of people’s needs before they received care was not always undertaken.

There were not always robust systems in place to monitor its delivery of care. Audit checks were not always robust in identifying improvements that were needed. Confidential information about people was not always kept securely.

Notifications that were required to be alerted to the CQC were not being sent.

There were sufficient numbers of staff to provide the support that people needed.

Where needed staff supported people with their food and drink. People told us that they were supported with meals and drinks.

People told us they were happy with the care they received and thought the staff were kind to them. They told us that staff treated them with dignity and respect and our observations supported this.

People told us that when staff were going to be late they would be informed. They said that they were always introduced to the staff before care commenced.

People and their relatives knew what to do if they needed to make a complaint and felt listened to.