Accommodating Care (Driffield)

Accommodating Care (Driffield) is a domiciliary care agency providing personal care to 16 people at the time of inspection. Not everyone who used the service received personal care. The Care Quality Commission (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

Quality Monitoring systems were not effective and failed to identify the shortfalls found at inspection. Records relating to the management of the service lacked detail and did not effectively monitor the service. Quality assurance records did not always contain accurate information or identify actions to make required improvements or learn lessons.

Risks to the health and safety of people were not always identified, monitored and mitigated. This included risks associated with individual health conditions and catheter care. Medicines were not managed safely, and recruitment was not robust.

People felt safe. Staff understood their responsibilities to report any safeguarding concerns. People and relatives spoke positively about the kind nature of the staff team. Staff knew people well and treated them with kindness, compassion and in line with their preferences.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 8 February 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the provider remained in breach of regulations. The service remains rated requires improvement.

This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We carried out an unannounced comprehensive inspection of this service on 28 November 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led, which contain those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Accommodating Care (Driffield) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment , safeguarding and management oversight at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about the recruitment of staff.

Since the last inspection we recognised that the provider had failed to ensure good governance. This was a breach of regulation and we issued a warning notice to the provider.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Accommodating Care (Driffield) is a domiciliary care agency providing personal care to 20 people at the time of inspection. 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

The provider had recently appointed a new manager who had developed good working relationships with the local authority and begun work to make improvements to the service. Improvements had been made to ensure the safety of people using the service and delivery of person-centred care. Further improvements were needed to monitor the quality of the service.

People received kind and compassionate support from a team of well-trained and well-supported staff. Staff supported people to be independent, engage socially and maintain hobbies and interests.

Staff knew people well and cared for people in the way they preferred. Staff were prompt and on-time to calls. There were systems in place to inform people if staff were running late.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was inadequate (published 29 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made however, the provider remained in breach of one regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the assessment and monitoring of the quality of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People were not always protected from harm and abuse. Internal and external systems were not followed to protect people and ensure their safety.

Potential risks to people were not always identified. Where risks were identified the information for staff was brief and did not detail how to mitigate risks to people and keep them safe.

Staff recruitment was not robust. Pre- employment checks were insufficient and employment gaps were not explored to ensure potential staff were of good character and suitable to work with vulnerable people.

People had assessments and care plans regarding their care and support needs. However, the care plans lacked important information and were not always kept up to date.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; However, the policies and systems in the service did not support this practice.

Complaints were not managed in line with company policy.

The service was not well-led and there was a lack of effective governance and oversight. Quality assurance processes were not completed and records for the running of the service were not always accurate or up to date.

Rating at last inspection and update; At the last inspection the service was rated requires improvement (published 4 April 2018). This service has been rated requires improvement for the last two consecutive inspections.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve.

At this inspection improvements were still needed and the provider continues to be in breach of regulations. This has resulted in the service being rated Inadequate overall and being placed in special measures. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months.

Why we inspected: This was a planned inspection based on the rating at last inspection.

Enforcement: We have identified breaches in relation to Regulations 19,12,16 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This provider did not ensure fit and proper people were employed at the service, did not ensure safe care and treatment of people using the service, did not manage complaints adequately and demonstrated a lack of robust quality assurance meant people were at risk of receiving poor quality care.

Following this inspection, we wrote to the provider to request an action plan and to gain further assurances for people’s safety.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Accommodating Care (Driffield) is a domiciliary care provider which supports people with personal care who live in their own homes in areas of the East Riding of Yorkshire. They support people with a range of needs, including people living with dementia. At the time of our inspection there were 48 people using the service.

Not everyone using Accommodating Care (Driffield) was receiving the regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in post at the time of our inspection that had been running the service since August 2017. Following the inspection the local authority advised us that the registered manager had served their notice and was due to leave the provider within a couple of weeks. A registered manager is a person who has registered with CQC 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.

Staff were knowledgeable about maintaining people's safety and how to report any abuse or allegations of abuse should they need to. However, we did find that safeguarding information had not been recorded centrally and the provider lacked oversight in this area.

Staff training schedules were not in place to identify training that had been completed and highlight when refreshers were due. Some staff records showed very little training and the provider did not have this information. We could not be sure that staff had received the training necessary to carry out their roles effectively. This was an area the registered manager was reviewing in order to ensure all training was current for all staff.

Disciplinary procedures were in place and the provider had utilised these when necessary. However, when errors had been identified and the disciplinary process opened, staff had not been offered additional training to support them and observations to check competency had not been considered.

Accidents and incidents were recorded in people’s individual care files. However, these were not always fully completed and lacked details of actions taken and referrals made to other health professionals. There had been no overall analysis or review so that lessons could be learnt.

Recruitment processes were not robust. The registered manager had obtained only one reference for some employees, identification documents were not always present and some application forms contained conflicting information that differed from the curriculum vitae provided. We could not evidence that the registered manager had questioned these discrepancies at the interview stage.

Risk assessments did not always contain sufficient detail to guide staff in how to mitigate risks and some had not been reviewed since 2015.

The provider had failed to implement regular checks to identify medicine errors despite their being recent issues with medicines administration. Since our inspection the local authority were supporting the registered manager to improve in this area.

People told us they received consistent carers that attended within thirty minutes either side of the allocated timeframes. People told us that staff offered choices to them and supported their independence. People felt that staff respected their privacy and dignity at all times and were competent and skilled to meet their needs

Policies and procedures were in place. However, these had not been regularly updated and some did not contain sufficient information to guide staff on current legislation and best practice.

Staff supervisions and appraisals had not been completed in line with the provider’s policy and procedures. Staff meetings had not been held regularly to support staff and gain their feedback to improve the service.

Staff supported people to maintain relationships with their families and friends. Relatives and representatives had been invited to attend reviews of their care and support needs.

People were supported to eat nutritional diets and staff offered them choices and knew people’s preferences. Daily notes contained information about tasks staff had completed during their visits and recorded important information, such as people's health and well-being, food and fluid intake and weekly weights for those people at risk of dehydration.

Staff told us that communication had improved in the service and they felt confident that the registered manager would address any concerns or issues they might have. People and their relatives told us that the registered manager kept in regular contact and was always helpful and polite. Some people told us that they had received a visit from the registered manager and that they felt they had really listened to them.

Satisfaction surveys had been completed by people and their relatives and the majority gave positive feedback. However, for those that contained complaints and issues there was no evidence that these had been addressed or that any actions had been taken.

The registered manager provided information on advocacy services so that people could make informed choices and gain additional support if required. Best interest decisions had been recorded and relevant health professionals and representatives had attended when people were unable to make decisions for themselves.

End of life support had been provided to people and compliments had been received from one of the families for the support and care shown during this time.

There was a lack of senior management oversight. Systems and processes were not in place to ensure that risks were mitigated and issues identified, analysed and improvements made. The registered manager had been attending calls and struggling to implement improvements to the service due to a lack of leadership support. Recently the organisation had employed a care coordinator to oversee rotas and support with daily duties.

Staff raised concerns that the provider found it difficult to maintain staff and senior management roles. Over the last 12 month period the registered manager had struggled with staff shortages and therefore improvements to service delivery had not been prioritised.

People's personal information was kept in locked cabinets to maintain confidentiality. The staff handbook included information about the data protection act and the responsibilities of staff.

We found three breaches of legal requirements relating to safe care and treatment, on-going governance of the service and staffing under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We did not speak with people who used the service during this inspection. We visited the agency office to speak with the manager about how they monitored the quality of the service and to review associated documents.

We found that the service had achieved compliance with this outcome. Satisfaction surveys had been distributed to people who used the service and spot checks had been undertaken in people's own homes that included an opportunity for them to express their views about the service they had received.

Staff meetings had taken place, staff had been having supervision meetings with the manager and training courses had been arranged. Staff had undertaken training on the administration of medication and medication audit forms had been introduced.

New monitoring systems had also been introduced to audit the number of missed calls and we saw that, as a result, these had reduced.

People's consent was obtained before care and support was provided. Where people did not have capacity to consent to care or treatment best interest decisions were made that involved the relevant people involved in the person's care.

Care records provided clear guidance to support staff to ensure people's needs were safely met. People we spoke with confirmed they were satisfied with their support. One person told us 'They are all nice girls'.

People who were supported with their medicines told us they received their medicines regularly. We visited one person who agreed we could audit their medicines. We found that a lack of checks and audits increased the risks of medication errors.

Appropriate recruitment policies were in place to check that people working at the service did not present a risk to people who lived at the service. However, we found there were gaps in the records for some staff. We raised this during our visit and asked the manager to address this. The manager contacted us following our visit to explain all recruitment records had been received and were available for future checks.

The provider did not have effective systems in place to check on the quality and safety of the service people received. On the day of our visit we wrote to the provider asking them to submit a report the following day explaining the actions they had taken to ensure improvements were made to the quality checks required to minimise the risks associated with supporting people with their medicines. We found the lack of a quality assurance policy impacted on the quality of care people received.