Background to this inspection
Updated
19 May 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.
Concerns about the standard of care were brought to our attention prior to this inspection. The Local Authority were made aware of these concerns.
This inspection was announced and took place on 22, 23 and 24 January 2018.
We gave the service 48 hours’ notice of the inspection visit because it was a small service and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in. The inspection was undertaken by one adult social care inspector.
We reviewed all the information we held about the service and also gathered information from the Local Authority.
We reviewed care records for six people receiving a service including associated records such as medication administration sheets and daily records. We visited four people in their own homes who were receiving a service, spoke with three staff including the registered manager and spoke with five relatives.
Updated
19 May 2018
This inspection took place on 22, 23 and 24 January 2018 and was announced.
At the last inspection on 3 May 16 we found breaches of the regulations, including Regulation 9 Person centred care, Regulation 12 Safe care and treatment and Regulation 17 Good governance. The service was rated requires improvements overall.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve person centred care, safe care and treatment and governance to at least good.
This small domiciliary care agency was providing personal care to people living in their own homes in the community. It provided a service to older adults and people with a learning disability. The number of people receiving a service had reduced from 19 to 10 people since our last inspection. There was a registered manager in post at the time of the inspection who explained the provider was reducing the number of service users within the service in preparation for moving to another premises/area.
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.
During this inspection we found continued breaches of the regulations. Risks were not always being identified or mitigated for people using the service, there was minimal information about people seen in their care plans and quality assurance systems were not robust. You can see what action we told the provider to take at the back of the full version of the report.
On our last inspection we found there was not enough person centred information about people receiving a service. We found on this inspection people living with dementia had no person centred care plan and only one person out of 10 had an "All About Me" care plan in place. An “All About Me” care plan is written to provide important information about the person. The provider had not met their legal responsibility and remained in breach of regulation; person centred care.
We found on this inspection the registered manager had conducted a survey but had not undertaken any other audits of their systems. For example, there had been no audits of medication administration records and we had not been provided with a statutory notification when appropriate. The provider had not met the legal requirements and remained in breach of regulation, Good Governance.
On our last inspection medicine management systems were not safe. Medication administration record sheets (MARS) were checked in people’s homes who we visited. Two out of the four people we visited in their own homes were being supported with their prescribed medicines. Both people’s MARS had gaps or a symbol X with no code to denote what this was referring to. We found other risks were not being identified or mitigated for people receiving the service. For example, emergency contingency plans were not clearly written in care plans for people. The provider had not met actions from the last inspection and remained in breach of safe care and treatment.
Mandatory training (which is essential training) being offered for staff was minimal and only included moving and handling training provided by the registered manager who was an approved trainer.
Staff had undertaken medicines awareness as part of the Care Certificate but had not completed a specific training course in safe medicine management. Staff competency checks were not seen in staff files so we could not be sure staff had been assessed as competent.
We were concerned there were not enough staff trained with the necessary skills to provide a good standard of care for people.
Care plans contained a bullet pointed list of tasks people needed support with in the morning, lunch, tea and evening with no specific times documented for people to check when they could expect to receive their care. We viewed detailed moving and handling risk/environment assessments but we found specific risk assessments relating to peoples’ health were missing.
Peoples respect and dignity were not always being upheld. We received some information of concern on this inspection related to how people and their relatives were not always treated with respect.
Staff we spoke with were not knowledgeable in safeguarding. We found there was a system in place to record and report safeguarding concerns but the registered manager told us there had been no safeguarding referrals made since the previous inspection in May 2016. The Safeguarding Authority confirmed they had received a safeguarding concern and they were looking into this.
The complaints process and system was not robust enough. There was a complaints log seen.
We checked recruitment practices within the service and found that appropriate checks were being undertaken to reduce the risks for people receiving care.
Supervisions and appraisals were seen recorded in staff files.
Staff had received an induction including the Care Certificate. The Care Certificate is an agreed set of standards that sets out the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It's made up of the 15 minimum standards that should be covered for all staff 'new to care' and should form part of a robust induction programme. All staff had completed the Care Certificate.
We received positive comments about some of the care staff and the registered manager.
There was a system of recording accidents and incidents. There were none logged at the time of the inspection.
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.