Background to this inspection
Updated
15 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
What we did before inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.
During the inspection
We spoke with one person who used the service and two relatives about their experience of the care provided. We spoke with four members of staff including the provider/registered manager, office manager and care workers. We reviewed a range of records. This included seven people’s care records and medication records. We looked at eight staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke with professionals who were connected with the service.
Updated
15 August 2019
About the service
Wellbeing Care Services is registered as a domiciliary care agency providing the regulated activity ‘personal care’ to people who live in their own homes in Bourne and surrounding areas. At the time of the inspection visit there were 12 people using the service.
People’s experience of using this service and what we found
Safe recruitment practices were not being followed. Recruitment records showed several staff were working without necessary pre-employment checks and criminal records checks which placed people at risk of abuse. People's care needs were not routinely assessed. We checked the care records of seven people and found only one person to have a care plan in place.
People were at risk of harm. Evidence in people's care needs assessments undertaken by the local authority highlighted several risks to people's health, but the provider had not incorporated this information into the planning of care and support. Medicines were not being managed safely. The provider’s medicines policy had expired. No information about how to administer medicines was held in care plans, there were no risk assessments in place to make the process safe and there were no checks or audits to ensure that medicines were being managed safely.
Staff were not being trained to meet the needs of the people they were caring for. There was no system for ensuring that staff were trained. Training records were not being updated and there was very little evidence to demonstrate that staff were receiving the training they required. There was no evidence that people's consent to care was routinely being sought. The lack of care planning had a direct impact upon this as there was nothing recorded to confirm that people were consulted and had agreed to receive care and support in the way that they wanted. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
There was no evidence in care files of people being supported to access other health and social care professionals. Care calls were frequently missed and were late, which had resulted in high levels of anxiety for people using the service.
It was difficult to establish if people were receiving care that was responsive to their needs, due to the lack of evidence of collaborative assessment and care planning. There was no evidence to confirm that people had been involved in the design of their care and that reviews of care had taken place regularly. Complaints and concerns were kept in a folder in the office location, but there was no evidence to confirm that people’s complaints had been fully responded to.
There were no governance frameworks in place, which meant the registered provider had no oversight of whether the service was meeting regulatory requirements. The registered provider had subscribed to a third-party organisation to provide policies and procedures for the service. The provider had allowed the subscription to elapse in October 2017 which has resulted in the provider having no up to date policies and procedures.
The provider had been working with a consultancy organisation to support them to build an action plan to address shortfalls in the service. At the point of the inspection, the registered provider had not begun to work on the actions contained within the plan but confirmed that this will be a priority in the future.
The provider had been providing personal care to people under a contractual agreement with another ‘prime provider’ in the local geographical area. Immediately following our inspection, the provider and the prime provider worked together to transfer peoples care back to the prime provider, which reduced the immediate risks to people using the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This was the first time the location had been inspected therefore there was no previous rating. This service was registered with us on 21 August 2018 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about staffing, medicines and safeguarding. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified breaches in relation to Regulation 9 (Person Centred Care), Regulation 12 (Safe Care and Treatment), Regulation 13 (1) (Safeguarding Service Users from Abuse and Improper Treatment), Regulation 17 (Good Governance), Regulation 18 (Staffing), Regulation 19 (Fit and Proper Persons Employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.
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.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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.