Archived: Fairmeadows Home Care Office G05

Updated 22 August 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 carried out this inspection because we had received information that staff were working without having had appropriate checks on their suitability to work with people.

This inspection took place on 4 July 2018 and was unannounced. This meant that the provider and staff did not know we would be visiting. We attended the office location on the 4 and 13 July 2018. We also visited five people in their own homes and contacted staff and people by telephone.

The inspection was carried out by two adult social care inspectors, and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Prior to our inspection, we checked all the information which we had received about the service including notifications which the provider had sent us. Statutory notifications are notifications of deaths and other incidents that occur within the service, which when submitted enable the Commission to monitor any issues or areas of concern.

We did not request a provider information return [PIR] due to the late scheduling of the inspection. A PIR is a form which asks the provider to give some key information about their service; how it is addressing the five questions and what improvements they plan to make.

We contacted the local authority safeguarding and contracts teams. We used their feedback to inform the planning of this inspection.

We spoke with eight people who used the service, seven relatives, the registered manager, two coordinators, the in-house trainer, Human Resources [HR] staff member, two senior care staff, and 12 care staff. We also contacted a social worker for their feedback about the service.

We looked at four staff files and nine care plans. We were sent additional information relating to recruitment, staffing and staff training following our inspection.

Updated 22 August 2018

Following a number of recent complaints and concerns, we inspected the service on 4 and 13 July 2018.

Fairmeadows Home Care Office GO5 is a domiciliary care agency. It provides personal care to people living in their own houses in Northumberland. It provides a service to older adults and younger adults. There were 60 people using the service at the time of our inspection.

We inspected Fairmeadows Home Care Office GO5 [hereafter referred to as Fairmeadows] in January 2016 when we found two breaches of regulations related to safe care and treatment and good governance. In July 2017, we inspected and found improvements had been made in each of these areas and rated the service good.

There was a registered manager in place. He was also the registered provider and director of the company. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found serious shortfalls in many areas of the service. The overall rating for this service has deteriorated from 'good' to '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 of 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 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.

At the time of our inspection, the provider had agreed with the local authority not to accept any new care packages.

There were shortfalls and omissions with the management of risk. Documented risk assessments were not always in place for identified risks such as bed rails and choking.

Procedures for the safe storage and administration of medicines were not always followed, and some medicines records were unclear which posed a risk to people.

Safe recruitment procedures had not been followed including appropriate checks by the Disclosure and Barring Service [DBS] and identity checks. Suitable numbers of staff were not employed to ensure calls could be completed in a timely manner.

People told us they felt safe with regular staff, but less so at the weekend when a high number of unfamiliar or less experienced staff supported them. Procedures for supporting people with finances were not sufficiently robust. Receipts for transactions carried out by staff on people’s behalf were not always available.

Office staff felt unsupported and were taking responsibility for the operation of the service. They were dedicated to supporting staff and people, who were, in the main, complimentary of the support provided by them. Office staff had not received formal supervision.

People were not always supported to have choice and control of their lives. Records did not demonstrate that staff supported them in the least restrictive way possible and policies and systems in the service did not always support this practice.

People were supported with eating and drinking but specific risks relating to eating and drinking and special dietary advice was not always recorded in people’s care records.

We observed a number of caring interactions between staff and people, and we saw that the privacy and dignity of people was maintained. Records however, did not demonstrate that people were always included and involved in their care.

Care plans were in place, but these were basic in design and lacking in individual detail. People’s relatives often left information around the home including instructions for staff about people’s needs and preferences. This information had not been formally incorporated into care records to ensure consistent and safe care was provided.

The complaints procedure was not always followed by the provider. We spoke with some people and relatives who told us they had had cause to complain and said that their complaints had been resolved. There was no evidence, however, of any response to the complaints of another relative.

The service was not well led. The registered manager and provider did not have an overview of the service and no audits had been carried out to monitor the quality and safety of the service. They had been spending time driving staff to visits and ensuring calls were covered which meant they had limited time in the office. The other director for the service was absent during the inspection. Staff told us the amount of time the other director had spent in the office in recent months had decreased.

There were gaps in records related to people, staff and the management of the service. There was confusion about the roles and responsibilities of staff working in the office which meant it was difficult to ascertain who was responsible for specific tasks.

There was no evidence that feedback had been obtained from people, relatives, staff or visiting professionals about the quality of the service.

Staff expressed concerns about the financial management of the service including concerns about their pay. Concerns were raised by staff about the financial management of the service. We used our regulatory powers to request information about the provider’s finances. The registered manager was unable to provide us financial information during the inspection because they did not have access to the necessary systems.

Following the inspection the provider wrote to tell us they planned to close the service and transfer the business to another care provider.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, the need for consent, receiving and acting upon complaints, fit and proper persons employed, staffing and good governance.

You can see the action we have told the provider to take at the back of this report.