10 March 2017
During a routine inspection
The service had a registered manager. 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.
People were not always kept safe. Whilst staff were able to recognise signs of abuse, they were unable to identify what protocols to follow if they had any concerns. As a result notifications were, not completed when safeguarding incidents occurred. The service did not complete or record any investigations to ensure that all steps were taken to prevent any abuse happening again
Risks were not assessed to keep people safe. This meant that staff did not always know how to manage a risk should one occur.
People were not supported with their medicines by suitably trained, qualified and experienced staff. Not all staff who administered medicines had received training in medicine management. There had been no check of staff competency prior to administering medicines. Some people had not received their medicines as prescribed. The impact and risk of this was neither reported nor assessed by the service.
The service did not have systems in place to ensure sufficient suitably qualified staff were employed to work with people. References, gaps in employment history and photographic ID was missing from staff files.
People received care and support from staff who did not have the necessary skills and knowledge to care for them. Mandatory and specialist training had not been completed by all staff working with people. Staff did not have an understanding of the Mental Capacity Act, and did not know how to use the principles of this when working with people. People were not supported to have maximum choice and control of their lives. Staff may not have been able to support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
People told us communication with the service was not good and they did not feel listened to. Complaints were not investigated and not responded to. There was no evidence of any concerns being properly documented by the service. People, professionals and relatives said that people were not always treated with dignity and respect. Confidentiality had on occasions been breached.
People did not receive care that was person centred, and tailored to meet their individual needs. Care plans did not contain sufficient information on how to support people, and were not reviewed regularly. Calls were not completed at the times requested by people, with some calls being delayed by several hours, whilst some were not completed at all.
The service was not well-led. The registered manager did not have an overview of the service. Audits and quality assurance documents were neither completed fully, nor understood, by the management team, as being important in maintaining and developing the service.
We found a number of breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff were not provided with appropriate training, competency assessment and performance appraisals as was necessary for them to carry out the duties they were employed to perform. The provider had not established an effective system that ensured their compliance with the fundamental standards. The fundamental standards are regulations 8 to 20A 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, 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. 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.