This comprehensive inspection took place on 2 and 3 May 2018 and was announced. We last inspected the service on the 4 and 5 April 2017 when we found a number of concerns. Options Home Care Limited is a domiciliary care agency and is based in Accrington, Lancashire. The service provides personal care and domestic support to people over the age of 18 years with a variety of health and social care needs who live in their own homes. On the day of our inspection there were seven people using the service.
The service had a registered manager in place, who was also the provider. 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.
At our inspection of 4 and 5 April 2017, we found breaches in the regulations; these related to the failure to adequately assess risks to people, recruitment processes were not sufficiently robust, a lack of auditing systems and policies and procedures did not reflect when the service were doing in practice. We therefore asked the provider to make improvements. We received an action plan from the provider indicating how and when they would meet the relevant legal requirements.
During this inspection we found no improvements had been made and the service was in breach of five regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included shortfalls in the effective management of risks of harm and abuse within the service, failure to ensure the recruitment of staff was safe, inadequate staffing levels, shortfalls in staff training, supervision and appraisals and failure to demonstrate oversight and compliance with the regulations by the registered manager.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals are concluded.
The risk assessments that were in place did not accurately reflect current risks and had not been reviewed. Those risk assessments did not direct staff on how to manage these or how best to support people. People who had been deemed as at risk of falls did not have a falls risk assessment in place to show how these risks were being managed.
Recruitment systems and processes in place were not sufficiently robust to ensure appropriate people were employed to work with vulnerable people. We saw the registered manager had not undertaken relevant risk assessments when employing people and gaps in employment had not been explored.
The provider had not employed sufficient numbers of suitably qualified, competent and skilled people. Records we looked at showed the only member of staff with previous experience in social care was the registered manager. New staff members without any experience in care had not received an appropriate induction.
The only training all the staff had received was a one day course which covered 12 different topics. The staff member we spoke with could not recall any of the information they learned during this course. Other online training courses were available but staff had struggled to pass these courses and no competency checks had been undertaken. Staff had not received any supervision to discuss issues related to their role and any learning and development needs.
Care plans we looked at did not reflect people’s current health care needs such as those at risk of falling. None of the care plans we looked at were person centred. They were basic and did not always direct staff on how to provide support to people. Many of the care plans had been handwritten and we struggled to read them. There was no evidence to suggest that people using the service had been involved in developing care plans or the reviewing of these.
We checked the registered manager was following the Accessible Information Standard. They told us they had not heard of it and did not know anything about it. Throughout the inspection, we noted the registered manager lacked knowledge and understanding around the regulations and best practice guidance.
Audits to monitor the quality of the service and make improvements were not being completed. There was no oversight of the quality and safety of the care being delivered either by the registered manager or by the service provider. . Surveys had been sent out and some had been received back, although the registered manager had not analysed these in order to identify if improvements in the service were needed.
All the people we spoke with who used the service told us they felt safe. One staff member we spoke with told us they had received safeguarding training but could not remember anything about it. However, they did tell us they would inform the registered manager if they had any concerns.
Staff we spoke with were aware of their responsibilities in relation to infection control. We observed personal protective equipment (PPE) was used when providing personal care or preparing food such as gloves and aprons.
The registered manager knew their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The service had not needed to make any applications to the court of protection to restrict a person. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
All the people we spoke with were complimentary about the registered manager and staff members. They told us their privacy and dignity was respected at all times and staff were reliable and in the main turned up on time.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measure 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.