Background to this inspection
Updated
16 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team was made up one inspector, Two Assistant Inspectors 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.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 7 February 2022 and ended on 16 February 2022. We visited the location’s office/service on 7 February and 9 February 2022.
What we did before the inspection
Before the inspection we reviewed the information, we held about the service, including notifications we had received. Notifications are changes, events or incidents the provider is legally required to tell us about within required timescales. We sought feedback from the local authority. We used this information to plan the inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spent time with and spoke with seven people using the service, four relatives, four members of care staff, the finance officer and the registered manager. This helped us assess and understand how people's care needs were being met. We reviewed records relating to six peoples care needs and the day to day running of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke with four health care professionals, a representative from Plymouth City Council's quality assurance and improvement team (QAIT) and safeguarding team and two relatives.
Updated
16 March 2022
About the service
Assistants at Hand @The Pearn is a domiciliary care agency (DCA). The service provides personal care services to people in their own homes. At the time of our inspection 14 people received personal care.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Risks to people were not managed safely. There were no established systems in place to monitor the quality of service. Medicines management was not based on current best practice which exposed people to a significant risk of harm and/ or not receiving their medicines as prescribed.
People were not protected against the employment of unsuitable staff as the provider failed to follow safe recruitment practices. Staffing rotas indicated there were sufficient staff to meet people's needs. However, the service did not deploy staff effectively and this had a negative effect on people's wellbeing and on occasions resulted in people not receiving their planned care visits.
Although some people and relatives told us they felt people received safe care, our findings were that people were not safe and were at risk of avoidable harm associated with their assessed care needs. The findings of our inspection identified a culture that was not based on learning. This means if and when things go wrong, the potential for re-occurrence was probable because there was no action taken to review, investigate and reflect on incidents.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (Published 23 January 2018).
Why we inspected
This inspection was prompted because we received concerns in relation to people's safety and the management and leadership within the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Assistants at Hand @The Pearn on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
At this inspection we have identified four breaches in relation to Safety, Recruitment, Staffing and the overall management of the service.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to work with the local authority to ensure people's safety. The provider has taken the decision to de register this service.
The overall rating for this service is ‘Inadequate’ and the service / in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.