This inspection took place between 4 and 7 of March 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to visit the office, talk to staff and review records. Phone calls to people were completed on 4 March 2017 and we visited the premises on 4 and 5 March. We made phone calls to staff between 5 and 7 March 2017.
The service provides personal care and support to people who live in their homes in and around the Derby area. At the time of this inspection 61 people received support from the agency, 48 of whom received support with their personal care needs.
The service is required to have 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.
The registered persons could not demonstrate medicines were managed safely and administered as prescribed.
The registered persons could not demonstrate people received care that was safe and consistent as care plans and risk assessments were not always in place. Monitoring of people’s health was not always completed in line with the provider’s own guidance.
The registered persons could not demonstrate all the required pre-employment checks had been completed on staff employed at the service.
Staff received training, however staff did not always follow good practice guidance in relation to medicines and their knowledge of other areas relevant to peoples’ care was not always in place.
Not all staff understood local safeguarding procedures and potential safeguarding incidents had not always been recognised and referred to the local safeguarding authority.
Not all staff were confident the support they received from their managers had been effective at resolving concerns or improving services.
Most, but not all people and their family members thought staff were caring; some staff practice did not always support the care and welfare of people.
Care was provided in ways to respect people’s privacy and promote their dignity. People were involved and felt listened to when their care was discussed. People’s care was reviewed with them, however this did not always lead to their care plans and risk assessments being updated when their care needs changed.
Complaints were not well managed or always investigated appropriately. Concerns and complaints were not used to improve the service. Not everyone felt confident to raise concerns.
Systems and processes designed to assess, monitor, improve and reduce risks in the quality and safety of services were either not in place, or where they were in place they were not effective. Actions taken to improve services had not always resulted in improvements. Staff were not always confident support from their managers would lead to improvements. Not everyone felt the service was led with an open style of leadership.
Policies and procedures did not always ensure quality services for people.
The registered persons could not demonstrate accidents and incidents were always recorded as appropriate and that any subsequent investigation and actions to reduce future risks had been taken.
Other healthcare professionals had not always been informed of changes to people’s needs in a timely manner.
The provider had a policy in place on the Mental Capacity Act 2005. We found mixed evidence on whether people’s rights had always been upheld and their views respected.
There were sufficient staff deployed to meet people’s needs.
People received care with their nutrition and hydration needs. Staff provided care and support to help people with their meals and drink in a way that met their known preferences.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this 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.
You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded.