The inspection took place on 1 and 8 August 2017 and was announced.The service provides personal care to people living either in their own home or the home of a family member. At the time of the inspection, approximately 20 people used the service and a registered manager was in post. 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 and associated Regulations about how the service is run. The registered manager was also the registered provider for this service.
People did not receive care in a safe way. People and their families experienced missed care calls and calls that were shorter than they expected. Systems in place did not effectively monitor and identify when people had a missed calls so that action could be taken promptly to prevent the incident happening again.
The registered manager also did not have systems in place to monitor how staff supported people with their medicines to ensure they received them in a safe way. People’s Medical Administration Records were not completed fully and no time was listed to indicate when the person received their medicines, despite this being highlighted at the previous inspection.
The registered manager did not assure herself of staff competency in supporting people with their medicines. Staff had received training at their induction but the registered manager told us this had not been reviewed since.
Staff did understand how to support people from abuse and who they needed to report their concerns to. Staff had received training and could explain their understanding of abuse. People were supported by staff that had had checks of their background to assure the registered provider of their suitability to work at the service.
People could not be assured that checks were in place to refer the person to a medical professional if needed. Guidance was not available to staff to direct them on what to do if they were concerned a person was not taking their medicines. Staff understood the importance of obtaining a person’s consent and explaining their care. People received choices in the food and drinks prepared for them.
People liked and valued the care staff but care staff did not always have time to spend with them because they needed to attend the next call. Staff knew about people’s care needs and could explain how people preferred to receive their care.
People did not have confidence their complaints would be listened or responded to. People had tried contacting the administration office did not always receive an explanation to their complaint by telephone or letter.
People were not always involved in reviewing their care to ensure the care met their needs and preferences. Risk assessments did not always show how people were involved in discussing their care needs as well as risks identified.
People’s care was not routinely reviewed and monitored. Systems were not in place to identify how people’s care had been checked to ensure that it had been provided in accordance with their needs. The registered manager could not confidently confirm how many people received care. The registered manager did not have a system for checking that people received care calls and that they received a call for the duration they expected. The registered manager did not also have a system for ensuring people received the help they needed with their medicines at the time they expected. People’s care was not updated regularly and we could not be assured that people received the care they needed.
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.