Archived: Expertise Homecare (Maidstone)

Updated 12 January 2019

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.

This inspection took place on 22 and 23 October 2018 and was unannounced.

Before the inspection we reviewed notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law. We did not ask the provider to complete a Provider Information Return because we inspected the service at short notice. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received from the provider about shortfalls they had found at the service and the action they were taking to address them. We also spoke with the local authority commissioner.

The inspection site visit activity started on 22 October and ended on 23 October. It included meeting people and their loved ones and talking about their experiences. We visited the office location to see the provider and office staff; and to review care records and policies and procedures.

The inspection team consisted of two inspectors.

We looked at five people’s care and support records, associated risk assessments and medicine records. We looked at management records including four staff recruitment, training and support records and staff meeting minutes. We observed people spending time with staff in their own homes and spoke to them about their experience of Expertise Maidstone. We spoke with the provider, five staff, and 5 people who use the service and their relatives.

Updated 12 January 2019

This inspection was carried out between 22 and 23 October 2018 and was unannounced.

Expertise Maidstone is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Not everyone using Expertise Maidstone receives 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 were 28 people receiving a service at the time of our inspection.

A registered manager was employed but they were not working at the service at the time of our inspection. 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 in May 2018. We inspected the service in response to concerning information we received from the provider about the risks to people, the recruitment of staff and the governance and leadership of the service. We found that the provider’s concerns were correct. During the inspection the provider decided to stop providing the service the following day as they were unable to ensure people’s safety. They worked with the local authority commissioning staff to support people to receive care from other providers.

The provider did not have the required oversight of the service. Robust checks on the service people received had not been completed to make sure people always received a good standard of care. People, their relatives and staff had been asked for their feedback, however any concerns had not been acted on and used to improve the service. Accidents and incidents had not been analysed and action had not been taken to stop them happening again.

There were not enough staff available to give people the support they needed, when they needed it. Staff often arrived late and told us they rushed between visits. Some visits had been cancelled and people’s relatives had been left to provide their care. The provider did not have sufficient staff available the day after our inspection to provide people’s care. They stopped providing the service at this time as they were not able to keep people safe.

Staff had not been recruited safely. Checks on the character of staff including Disclosure and Barring Service (DBS) criminal records checks had not been completed. Staff were not supported to meet people’s needs and some had not completed the training they needed to fulfil their role. Checks had not been completed to make sure training had been effective and staff were competent. Staff were unclear about their roles and responsibilities.

Staff felt supported by the office staff but were demotivated. There was not a shared vision of a good quality service. An experienced member of staff was not available to provide the support and guidance staff needed, including outside of office hours. Records in respect of each person were not accurate and complete and were not always kept secure.

Staff had not considered people’s equality, diversity and human rights when planning their care and there was not a person-centred culture at the service. People did not receive care tailored to them. Effective assessments of people’s needs had not been completed and risks had not been identified. No guidance was available to staff about how to keep some people safe and provide each person’s care in the way they preferred. Guidance about other people was not specific and detailed. People had not been asked about their care preferences at the end of their life.

Staff knew the signs of abuse and raised any concerns they had with the registered manager. However, these concerns had not been shared with the local authority safeguarding team so they could take action to keep people safe. Staff including the assistant manager did not know they could whistle blow about concerns they had. Staff were not supported to followed safe practices to prevent infections and there were no stocks of disposable gloves in the correct size.

People and their representatives told us they were confident to raise any concerns they had with office staff. However, an effective system to receive, investigate and respond to complaints was not in operation and some complaints had not been acted on.

People were supported to have maximum choice and control of their lives and the policies and systems were in operation to prevent this. Staff supported them in the least restrictive way possible. Everyone was able to make decisions for themselves and staff supported them to do this.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury. This is so we can check that appropriate action had been taken. We had not been notified of all significant events at the service.

People told us the staff were kind, caring and friendly. People were supported to eat and drink enough.

People’s medicines were not always managed safely, staff had not received the training to understand how to administer some medicines, and this impacted on people and their wellbeing.

Staff recognised when people were unwell but did not take the appropriate action and did not support family members to access appropriate support.

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.