18 September 2018
During a routine inspection
We last carried out an inspection at this service in April 2016 and the service was rated ‘Good’ overall, with a rating of ‘Requires Improvement’ in the ‘Well Led’ domain. This was because we identified concerns in relation to late care calls and how the provider monitored the quality of the service provided. At this inspection we found that these issues continued to be a significant concern. In addition, we identified concerns in relation to how the provider identified and managed risks to people, poor quality care planning and delivery, poor quality training, poor record keeping and complaints management. Much of the feedback from people and staff regarding the quality of the care and support was poor, and showed that changes were not being implemented or embedded within acceptable timescales. As a result, the service has been rated inadequate.
PCHCS is a domiciliary care service providing personal care and support to people in their own homes. At the time of our inspection, the service was providing care to 18 people.
The service had 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.
People did not receive their care visits on time, and care visits were frequently cut shorter than the allocated time. This meant that people were placed at risk of neglect, medicines not being administered at the correct intervals and not having their care needs attended to within a reasonable time. The service had a system for monitoring their calls and identifying persistent issues that required improvement but it had not been used effectively.
People had care plans and risk assessments in place but these were poor in quality and lacked sufficiently up-to-date, relevant and personalised information to enable staff to carry out their care effectively. There were concerns in relation to people having consented to the care provided and the provider’s understanding of the Mental Capacity Act 2005 was poor. People were asked for their views through surveys and quality monitoring calls but issues identified were not resolved. People had mixed views as to whether they felt cared for and were treated with dignity and respect.
Staff recruited to the service did not always have suitable references in place, and there were gaps in employment histories which had not been accounted for.
Staff training was inadequate and left staff to provide care to people for which they had not been fully trained. Their competency was not assessed to ensure they were able to provide this care safely to people.
Understanding of how to protect people from harm and how to report incidents of concern was insufficient throughout all levels of staffing. This had led to a significant increase in investigations into incidents by the local authority.
People did not always feel confident that complaints would be resolved, and expressed concerns that the management were not always responsive. Records, including those in relation to complaints were chaotic and frequently incomplete and there were no effective systems in place to monitor these.
The provider oversight of the service was poor and they had little understanding of their regulatory responsibilities.
Feedback from people was not used to make improvements to the service and little meaningful monitoring of quality was carried out by the management team.
The service was slow to make improvements following prompting by the local authority and the Care Quality Commission, and did not take a proactive approach to developing the service.
Notifications of reportable incidents were not made as required by law.
The overall rating for this service is 'Inadequate' and the service was put into 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.
This inspection identified multiple breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. Following this inspection we took action to cancel the Provider's and Registered Manager's registration. This means that they are no longer legally permitted to provide this domicilliary care service.