Archived: Water Gate Support Services Limited

Updated 27 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We received anonymous information of concern on 26 March 2018 and 4 April 2018 in relation to unsafe recruitment practices, no training being provided and that care workers were not being paid. We spoke with local authorities to see if they had received any similar concerns and followed this up at the inspection.

The inspection took place on 17 and 19 April 2018 and was announced. The provider was given 24 hours’ notice because we needed to ensure somebody would be available to assist us with the inspection.

The inspection was carried out by one inspector. Inspection activity started on 17 April and ended on 1 May 2018. We visited the office location on 17 and 19 April 2018 to see the registered manager, director and to review care records and policies and procedures. Following the site visit we made calls to people who used the service, their relatives, care workers and health and social care professionals.

Before the inspection we reviewed the information the CQC held about the service. This included their registration documents and information from members of the public. We also spoke with local authority commissioning teams and used their feedback to inform our planning.

Before the inspection we requested the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This form was not completed.

We were unable to speak with any of the people using the service as they were all unable to communicate with us but we spoke with four relatives. We also spoke with nine staff members. This included the registered manager, the director and seven care workers. We looked at five people’s care records, nine staff recruitment and training files and records related to the management of the service.

Following the inspection we spoke with eight health and social care professionals who worked with people using the service for their views and feedback.

Updated 27 June 2018

This comprehensive inspection took place on 17 and 19 April 2018 and was announced. This was their first inspection since registration with the Care Quality Commission on 11 April 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger adults with complex care needs. At the time of the inspection they were supporting seven people in the London Boroughs of Hackney, Enfield, Islington and Tower Hamlets. Not everyone using Water Gate Support Services Limited receives a regulated activity; 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. A registered manager is a person who has registered with the Care Quality Commission (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.

The service did not have appropriate systems in place to protect people from harm. People who lived with specific and complex health conditions had not had the risks associated with these conditions assessed. Risk assessments were not in place to ensure their safety and welfare. There was no guidance for staff to ensure care tasks were carried out safely or evidence that reviews took place if people’s needs changed.

People were supported with their medicines without a proper assessment in place to ensure they received their medicines safely and effectively. No records were available to confirm the level of support that people needed or if staff had received the necessary training.

The service did not follow a robust recruitment process to ensure staff had the necessary checks and were suitable to work with people using the service. References had not been sought and not all background checks had been completed.

People were not always protected from the risk of potential abuse because there was no evidence the provider responded or acted appropriately to incidents or concerns. There was no evidence any disciplinary procedures had been followed in response to the concerns we were told about.

Staff did not receive the required induction, training, shadowing opportunities and supervision to undertake their role. The registered manager acknowledged they were in the process of looking for a company to carry out their mandatory training. There was no evidence staff had received training in complex areas of care, such as percutaneous endoscopic gastrostomy (PEG) feed management.

Requirements of the Mental Capacity Act 2005 (MCA) were not met. The provider did not have a clear understanding that there should be signed consent forms in place and no records were available to confirm this for all of the people using the service. There was no evidence to show that staff had received training on the MCA.

People who were supported with their nutrition and hydration did not have their needs assessed, risks identified or preferences recorded. There was no information or guidance for staff to follow to support them to manage people’s nutritional needs and minimise the risk of their health being compromised.

People’s relatives told us that their regular care workers were kind and caring and knew how to support them. However when replacement care workers were used people received inconsistent levels of care, with issues about training and missed visits being highlighted by relatives.

People were at risk of receiving care that was not person centred or specific to their needs as assessments had not been carried out and care plans were not in place. There was no assurance that the care people received reflected their wishes and how they wanted to be cared for, including end of life care.

The registered manager told us that they had not received any complaints or concerns in the past year. However, relatives and health and social care professionals told us otherwise. There was not an effective system in place to deal with people’s complaints as no records were available to show the concerns and complaints had been followed up appropriately.

The provider failed to have effective quality assurance and management systems in place to monitor the care and support provided to people who used the service.

There was a lack of leadership, direction and oversight of people’s care which led to people experiencing inconsistent care and put them at risk of unsafe care. There was a lack of an open and transparent culture as we were given misleading and inaccurate information throughout the inspection.

Issues with non-payment of staff had an extremely negative impact on the service that people received. Relatives and health and social care professionals told us that there were times when care workers had not turned up. Relatives spoke positively about their regular care workers who continued to work despite their payment issues.

Due to the concerns we found at this inspection we served the provider with an Urgent Notice of Decision (NoD) on 27 April 2018 under our regulatory powers to impose a condition on their registration. The registered provider must not provide personal care to any new person without the prior written agreement of the CQC. This also included any person who had previously received personal care. We also asked the provider to send us in an urgent action plan to set out how they intended to address the concerns we identified.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care, consent, safe care and treatment, acting on complaints, good governance, staffing and fit and proper persons employed. 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.

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.