OFFICE

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

OFFICE (known as Golden Hands Home Care) is a domiciliary care agency providing personal care. The service provides support to people with a physical disability or sensory impairment. At the time of our inspection there were 29 people using the service.

People’s experience of using this service and what we found

Right Support: Care visits were organised to suit staffing availability, and not to consistently meet people’s needs and preferences.

People were not always supported by staff of their preferred gender to meet their values and support a sense of dignity. Agency staff were not always aware of people’s specific needs.

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.

However, whilst regular staff promoted independence and considered capacity and consent, the systems in place at the service did not always enable staff to provide the right support.

Staff received an induction, mandatory training, and spot checks to support their development. Staff did not receive specialist training in supporting people with a learning disability and or autistic people. Some training was out of date.

Right Care: Whilst staff were described as being friendly, kind and compassionate, the service was not consistently person-centred due to provider shortfalls in oversight and monitoring.

Safeguarding measures were inconsistent, which meant people were at increased risk of harm or not receiving the right care. People told us they did not have access to their up-to-date care plan, or involvement in regular reviews.

Equality and diversity characteristics were considered as part of the care planning process.

People told us staff respected their privacy and independence.

Right Culture: The ethos, values, attitudes and behaviours of leaders did not ensure all people using the service could lead confident, inclusive and empowered lives.

Limited action had been taken since the last inspection to drive improvement at the service. Registered persons and the management team were not responsive to people raising concerns, or to professional feedback.

There was a poor understanding of legal and regulatory requirements. Systems for oversight and governance were absent, poorly developed, incomplete, or ineffective.

Whilst the management team completed care visits to people in their own homes, and were described as approachable, there was no robust strategic oversight for the service in place.

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 22 June 2019). 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 the provider remained in breach of regulations. At our last inspection we recommended that the provider fully explore all gaps in staff employment history during recruitment and keep a log of all missed calls at the service. At this inspection we found improvements had not been consistently made.

Why we inspected

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

We carried out an announced comprehensive inspection of this service on 23 May 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 governance and oversight.

We undertook a focused inspection in relation to the key questions Safe, Responsive and Well-led to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found there were continued concerns about governance and oversight which impacted on other areas of the service, so we widened the scope of the inspection to become a comprehensive inspection, which included all of the key questions.

The overall rating for the service has changed from requires improvement to inadequate. 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 OFFICE on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to dignity and respect, safe care and treatment, safeguarding people from abuse, governance and oversight and staffing. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We have issued the provider with a Warning Notice.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The Office is a domiciliary care agency and provides care to people living at home in the community. This service supports older people and people living with dementia. The provider is Golden Hands and at the time of our inspection there were 60 people using the service, of which 41 people were in receipt of personal care.

Rating at last inspection: Requires Improvement and the report was published 01 June 2018.

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

People’s experience of using this service:

At the last inspection we found shortfalls in areas such as the recruitment and training of staff and overall governance. At this inspection we found that while improvements had been made in some areas there was still work to do. The service met the characteristics of Requires Improvement.

Medicines were better managed and while we found some shortfalls, practice followed professional guidance.

There were improved systems in place to recruit staff and ensure their suitability before they started work at the service. We have made a recommendation about checking for gaps in employment as part of the recruitment process.

The manager had started the process of developing oversight systems, but these had not identified some of the areas that we identified at the inspection such as gaps in documentation.

The registered manager and provider were not fully aware of their regulatory responsibilities and had not made notifications as required by legislation.

Incidents were not always recognised as safeguarding and the agency procedures were not followed.

There was a complaints policy in place, but we could not see that people’s concerns were investigated and addressed.

People received support from staff who knew them well and stayed for the agreed time.

Staff received training to develop their skills. Staff told us that they were supported in their role and the management of the service was approachable and helpful.

People were supported to eat and drink and maintain a balanced diet.

People were referred for specialist health care support when needed.

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

Care plans were in place and were regularly reviewed.

Enforcement. Action we told the provider to take refer to the back of the full report.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

The inspection was announced and we gave the provider notice as we needed to make sure that someone would be at the office when we visited.

There was a registered manager in post. 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.

This was the first inspection of this service since it was registered with the Care Quality Commission (CQC). At this inspection we found shortfalls in areas such as medicine administration, recruitment and training. The provider’s quality assurance systems had not identified these shortfalls. Staff recruitment was not robust and did not ensure that people were protected. Staff were provided with training but this did not provide practical guidance to staff on areas such as moving and handling. Competency checks were not undertaken to ensure that staff understood and implemented what they had learnt. Accurate records were not maintained of people’s medicines which meant that people were at risk of not receiving their medicines as prescribed.

The agency had expanded relatively quickly and the registered manager’s focus during their first year had been on the direct provision of care. They were open with us about some of the challenges that they had faced in the first year of operation and acknowledged that this had meant that they had not fully carried out some management tasks and oversight. The agency had not identified key risks and, as a result of what we found, we have made requirements in the areas of governance, medicine management, training and recruitment procedures. We have also recommended that they provide clearer guidance to staff on local safeguarding procedures and update their care plans to ensure that staff have the information they need on areas such as consent and working with people with dementia.

Despite the shortfalls, people’s day to day experience of the agency was good. People told us that staff were reliable and punctual. There were clear arrangements to respond to issues outside office hours. Staff were alert to changes in people’s wellbeing and responded appropriately when people became unwell. Care staff maintained good relationships with people who used the service and their families. People told us that staff were obliging and helpful and they were enabled to express their views and have a say in how they were supported.

Assessments were undertaken before people started to use the service and staff were provided with guidance on people’s preferences in an informative care planning document. The agency was described as helpful and people told us that that they addressed any concerns and complaints promptly.

Staff morale was good and staff told us that they well supported by the registered manager who was visible and approachable.

You can see what action we told the provider to take at the back of the full version of the report.