Archived: Direct Health (Kettering)

Direct Health (Kettering) is registered with the Care Quality Commission (CQC) to provide personal care and delivers a domiciliary care service to people living in their own homes. At the time of the inspection Direct Health (Kettering) was providing care and support to 112 people.

There was not a manager in post registered with CQC however; the provider had recruited a manager who was in the process of submitting an application to CQC to become the 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.

During our inspection in July 2016 we found that there was a systematic failure in all areas of the service and people were not always receiving their planned care. We identified that the provider was in breach of eight Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We placed the service in special measures and imposed conditions on the provider’s registration preventing new packages of care and requiring them to provide monthly reports to CQC. The provider has submitted these reports as required; these have been analysed and indicated that improvements had been made in these areas.

However at this inspection we found that the provider had not provided enough resources to ensure that all the necessary improvements were made and to meet regulatory requirements. Although the provider had placed some additional senior staff in the branch during the last six months and the manager had developed action plans to address the failings in the service, the provider had failed to supply sufficient resources to implement the action plan in a timely way. It is a concern that it took further intervention from CQC before the additional resource was allocated to the service.

We found that most people did not receive care at regular times from staff that knew them. The staff rotas showed that staff were allocated for the convenience of the service and did not always take into account people’s needs or preferences. Staff did not follow the rotas they had been allocated.

There were not enough staff to provide people’s care; the office staff and the manager were often providing care in the evenings and weekends as there were no appropriate contingency plans for unexpected absences. Staff had not received all of the training and supervision they required to carry out their roles. In our last inspection in July 2016 we identified serious concerns with staff knowledge and skills in safeguarding and moving and handling; not all staff had received the required updates or training since our last inspection.

People who used the service and staff did not always have access to on-call staff or the manager during evenings and weekends, as the on-call staff were providing care.

People did not always have risk assessments that reflected their current needs or care plans to mitigate these risks. Staff did not always have clear instructions about the care people required.

People were protected by the manager and staff who understood their roles and responsibilities to safeguard people. The manager raised, responded and investigated safeguarding concerns and kept clear records of concerns that had been raised.

People received their medicines safely. The provider had systems in place to monitor the management of medicines and take action where issues had been identified.

People knew how to complain and the provider had systems in place to manage people’s complaints in a timely way and take action to resolve them.

We identified that the provider was in breach of four of the Regulations of the Health and Social

Care Act 2008 (regulated activities) Regulations 2014 (Part 3).

This service has been in Special Measures for the last six months. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to have made significant improvements within this timeframe. During this inspection the service failed to demonstrate to us that sufficient improvements had been made and remains rated as inadequate in the Safe, Responsive and Well Led domains. Therefore, this service remains in Special Measures.

As not enough improvement has been made within the allotted timeframe, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This could 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.

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.'

There was no registered manager at the service. The person managing the service was a registered manager for a different location with the same provider. This manager had managed Direct Health (Kettering) for seven months.

There was a systematic failure in all areas of the service which led to people being neglected and abused. The provider had a lack of insight into the manager’s failure to follow their processes. This meant that all aspects of the service were failing and people were not always receiving their planned care.

People were subject to alleged abuse which had not been reported to the appropriate authorities or acted upon. The lack of systems to prevent and identify abuse led to potentially abusive situations continuing for people for over four months. People continued to be at risk of harm due to the lack of managerial oversight and systems in place to protect people.

People were at risk of serious harm as they did not always receive their medicines safely. There was no system in place to establish what medicines people were prescribed, or to record these or administer people’s medicines to them safely. There were no systems and processes in place to monitor that people had received all of their prescribed medicines.

People were at risk of harm as there was no managerial oversight of telephone calls being received by office staff from people who used the service, their relatives and staff. Telephone calls were being received that identified that people were being subjected to abuse, missed calls, missed medicines, missed meals and changing care needs. These telephone calls were not acted upon or checked to ensure that appropriate action had been taken. Staff receiving calls failed to recognise the significance of what they were being told and issues such as suspected abuse and missed calls were not escalated to the manager.

People did not always receive their planned care, or receive calls at times that were their preference as there was a lack of co-ordinated allocation of calls. Staff allocated calls for the convenience of the staffing rotas and did not take into account the effect on people. As a result, people were left for long periods without personal care, meals and medicines and in some cases this meant a loss of dignity.

People’s verbal complaints had not been acknowledged or responded to. Written complaints had been acknowledged, but the information from the complaints did not drive improvement.

People were cared for by staff that did not have the guidance and support they needed to carry out their roles. Staff competencies were not checked and staff concerns were not taken seriously.

The provider’s systems and processes designed to monitor the quality of the service were not always followed. Internal audits and checks did not identify issues which were affecting people's safety and well-being. The response to any issues that were identified were inadequate and did not improve the service.

We identified that the provider was in breach of eight of the Regulations of the Health and Social

Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and one Regulation of the Care Quality Commission (Registration) Regulations 2009 (Part 4). We took urgent action to impose conditions on the location’s registration:-

1. to prevent the service taking any new packages of care and

2. provide analysis and reports relating to all aspects of medicines management, call allocation and calls to the service by service users, their relatives and staff.

We have taken further enforcement action of which you can see details at the end 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 complete our enforcement action of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

We sent questionnaires to 59 people who used the service. We spoke with eight people. We found that people were broadly satisfied with the quality of care that they experienced. We found that people had no serious concerns but they felt that their care had been better when they had been visited by regular care workers. People also told us that punctuality of visits had been variable.

One person's comments were representative of those people who had reservations about the provider. They told us, "I have the same carers apart from at weekends when we get other carers. We've had problems with timekeeping. The care is good from the regular. The non-regulars don't all know what they should do. Not all of them look at the care plan." Most people had mainly positive experiences. One person told us that they were pleased with their regular and non-regular care workers. A relative told us, "The carers are very good. They are punctual and we have a regular carer apart from at weekends. The weekend carers are good."

We found that the provider had made significant improvements to the planning and delivery of care since our last inspection in March 2013. The provider had an action plan to build upon that improvement.

When we looked at records of calls made to 12 randomly selected people in February 2013 we found that 42 per cent of all calls had been either 30 minutes early or late. We also found that of all the calls made only 52% had been made by regular care workers.