Archived: Blades Enterprise Centre

This inspection was undertaken on 9 and 13 November 2017 and was announced. We gave the service 48 hours’ notice of the inspection site and office visits because the service is small and we wanted to ensure the sole director and manager would be available. We also wanted to arrange to visit some people who used the service in their own home.

This was the first inspection of this registered provider. The inspection was prompted in part as a result of ongoing concerns that the registered provider was operating in breach of their conditions of registration, in that they were operating from a location address that was different to the address they had registered. This had been brought to their attention by the CQC, and they had been provided with opportunities to have applications validated to rectify this and appoint a registered manager, but they had failed to achieve this. 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.

In addition, the local authority had raised concerns with the CQC about the service being unable to meet requirements of their contract with them and they had withdrawn that contract. Some people had chosen and were able to remain with the service, because they received funding directly from the local authority to purchase the care from services they chose as appropriate to meet their needs.

The sole director of the organisation was currently managing the service and we will refer to ‘the director’ as the person with the responsibility for oversight and management of the service at the time of inspection.

At the time of the inspection the agency was supporting approximately 11 people and employed approximately 15 staff.

We asked the director to arrange visits to people in their own homes. We carried out those visits two days before we carried out a visit to the office base. The director was given two days’ notice of the inspection as we needed to be sure they would be available.

Governance systems and processes were not in place to ensure the service met regulations, assessed, monitored and improved the quality and safety of the service and mitigated risks relating to the health, safety and welfare of people and others.

There was an assessment of people’s needs, choices and preferences that had been developed into a plan of care to inform staff of the care and support to be delivered. These were complex and difficult to navigate with three sets of records kept, sometimes with conflicting information and information that was inaccurate. In some instances the record did not provide sufficient information about how staff should manage risks presented in the course of their duty.

There were sufficient numbers of staff to provide a regular team of care staff for people, but information and documents were not always available for all of those staff to assure us they were safe to work with vulnerable people.

The systems and processes in place for the management of medicines were unsafe.

Systems to control the spread of infection required improvement by ensuring a bare below elbow procedure and that staff removed gloves between tasks to prevent the spread of infection, in accordance with the service’s own policy and procedure statement.

Staff had not always received training relevant to their role and their competence in their role assessed.

People were supported to eat and drink in accordance with their assessed needs and plan of care.

The premise used for managing the regulated activity required improvement in its maintenance so that it was fit for purpose. The service had not provided mobile telephones for staff and they were expected to use their own for the purpose of carrying out the regulated activity.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, but the directors lack of knowledge of the Mental 2005) (MCA) and policies and systems in the service placed this practice at risk.

Not everyone who used the service had built positive and meaningful relationships with all staff that provided care for them and some reported they did not feel they were treated with consideration and respect. Communication was a barrier to some people who said they felt some staff did not understand them.

The system and process in place for the management of complaints was ineffective as it did not demonstrate the director had acted in an appropriate way to manage complaints that had been made. Not everyone was confident that if they reported any complaints they would be acted on.

There was not a credible strategy in place to support the delivery of high quality care and support, promoting a positive culture that achieved good outcomes for people.

There was not an effective governance framework where risks and regulatory requirements were understood and managed.

The inspection found a breach of the Health and Social Care Act 2008, a breach of the Care Quality Commission (Registration) Regulations 2009 and nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

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.