17, 22 and 30 September 2015
During a routine inspection
This inspection took place on 17, 22 and 30 September 2015. The inspection was announced as the service provides domiciliary care and we wanted to ensure somebody was in the office we could talk with about the service.
We previously inspected this service on 06 September 2013 where no concerns were identified.
This was a planned inspection, although we had been made aware of some concerns through colleagues within the safeguarding team of Southampton City council.
Future Home Care Southampton provides ongoing support to 34 people who have a learning disability. This is through a domiciliary care service providing support workers to people living in a range of independent living services managed by the serevice. These are located within Southampton city and parts of Hampshire. There was a registered manager in place who oversaw all of these projects. 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.
At the time of our inspection all of the services provided in Southampton were due to be transferred to other providers to deliver support to people in their homes. As a large number of staff had left Future Home Care Southampton, people were not receiving their full package of support due to staff shortages. This had led to concerns being raised by commissioners and the involvement of the safeguarding team.
Some people were not receiving a safe service. Whilst staff were aware of how to identify and report abuse, staffing was inconsistent and management support was not always available. Staff had not received updates on safeguarding training.
Risks to people whilst receiving personal care had been assessed and were clear on steps required to reduce the effect of those risks. However, for a majority of people those risk assessments had not been reviewed and there were no records of amendments to those risks due to changes in the person’s needs.
There were insufficient numbers of staff to meet people’s needs. A large number of staff had left the service and people’s hours of support were not always delivered according to those identified. The provider had not prepared a contingency plan to predict how to support people as a result of the large loss of members of staff.
People’s medicines were not always managed safely. Established record keeping systems were in place and for most people these were accurate and up to date. One person’s controlled drugs register had not been updated and administration of medicines had not been recorded appropriately.
Staff had not received regular supervisions and had not received any training since the beginning of 2015. New staff did receive an induction training programme and had received a number of basic training events that gave them some understanding of their role and how to support people.
Some people lacked the capacity to make all decisions or consent to their care. Best Interest decisions were made but not all of these were recorded. General mental capacity assessments had been undertaken but these did not relate to specific decisions staff were making on behalf of people.
People were supported to eat and drink enough although where some people had specific dietary needs associated with medical modes of receiving nutrition, not all staff were trained or skilled to support them. Specialist health care professionals were available to people but they did not always get medical attention when they required it.
Staff were caring towards people and where they had built good relationships with people they had developed good communication systems. Where staff had left the service, some people had lost valuable relationships with staff they trusted and who knew their needs. This meant that their views were not always known and they were not involved in the changes to the service. Staff respected people’s dignity and privacy. People were comfortable with the staff who supported them.
People’s care plans were personalised and there was information about each person’s individual preferences, likes and dislikes in their care records. However care plans were not regularly reviewed and most were not up to date. People told us they did not understand why the service was changing and were unsure of when changes were going to happen and who would support them. The provider had tried to engage with them and had sought their opinion on the quality of the service but had not included them as much as they should have been in the specific changes at the time of our inspection.
For people who were going to continue to receive a service from Future Home Care Southampton there was an open, inclusive and empowering positive culture. For other people this had changed due to the difficulties experienced in maintaining their services during this transition period.
The service was not well led due to the priorities of trying to ensure a continued delivery of the service with a large number of staff vacancies. This had taken over a large proportion of management time and other areas of service delivery and continuity had been overlooked. This impacted on the quality of care delivered and affected the support people received.
During this inspection we found the service to be in breach of several of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.
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.