Archived: Alexios

Updated 8 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 25 and 26 July 2017 and 02 August 2017 and the first day was unannounced. The registered manager was not available to assist with the inspection. The office manager facilitated the inspection.

The membership of the inspection team comprised of one adult social care inspector and a medicines inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for elderly people. At this inspection the expert by experience undertook telephone calls to people who used the service and their relatives.

Before our inspection we reviewed the information we held about the service. This included the last inspection report and notifications the provider had made to us. We asked the local authority commissioners and the safeguarding team for their views about the service. They did share some information with us.

During the inspection we spoke with eleven people who used the service, five relatives and a person from a local visiting service who was a regular visitor to a person’s home. We spoke with six members of staff and the manager and four members of the office staff. We visited five people in their homes. The registered manager was unavailable for the duration of the inspection dates.

We looked at the care records for 14 people who used the service and medicines administration records for nine people. We also looked at the recruitment, training and supervision records within five staff files, minutes of meetings and other records relating to the management of the service.

Updated 8 September 2017

This inspection took place on 25 and 26 July 2017 and 02 August 2017 and was unannounced on the first day. Alexios was previously known as Carewatch – Bolton. In January 2017 the service changed its name to Alexios. There were no changes to the nominated individual who was also the registered manager.

The last inspection took place on 21 September 2016 and was rated as Requires Improvement. There were five breaches of the regulations in relation to person centred care and assessment , safe management of medicines, dealing with and responding to complaints, inadequate record keeping, training and development and staff supervisions.

At this inspection we found very little improvement had taken place from the last inspection and continual breaches of the regulations in respect of person centred care, medication, complaints, governance, staffing provision and staff training.

There was a registered manager in place who was also the nominated individual. 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 and associated Regulations about how the service is run. There was also an office manager in post supporting the registered manager. There was no evidence to show that the registered manager had oversight of the management of the service. There was no evidence to show when the registered manager was in the office. The management arrangements were not satisfactory. The governance of the agency and ensuring that it provides a good quality of care in a safe and consistent manner to service users is lacking. Regulations where breached at the last inspection and despite the Provider submitting a plan of action to the Commission to address these breaches the service remains in breach. The action plan had not been addressed.

Some people we spoke with told us they felt safe with their regular carers who visited them; however many did not feel safe at times when unknown care staff came to their house. There were numerous missed calls and late visits which had the potential to seriously impact on the health and wellbeing of service users.

There were insufficient staff to cover the work load given and staff we spoke with told us they were not able to get to calls on time which resulted in late or missed calls. We saw for one person who had eight visits a day that on 22 July 2017 records showed there had been only six visits, on the 24 July 2017 only two visits were recorded and on the 02 August 2017 we saw that the 14.30 visit for medication was 40 minutes late. This meant that medicines were not being in a safe and timely manner and people’s health and safety were at risk.

Medicines systems were unsafe. There were gaps in the recording on Medication Administration Records sheets (MARs) and time specific medication had been given late or missed and this placed people at significant risk of harm.

There was safeguarding policy in place. Staff spoken with had not received up to date training in safeguarding or the Mental Capacity Act 2005 (MCA). This meant that staff may be unaware of how to recognise different types of abuse and the ways they can report concerns.

Environmental and personal risk assessments were not undertaken to help ensure the safe delivery of care and use of equipment. Staff had not undertaken appropriate infection control training. This meant that staff were not aware of assessing risk of, and preventing, detecting and controlling the spread of infection.

There was a staff induction book for new staff to complete on commencing work. The training record was not thorough and essential training and specialist training had not taken place. This meant that people were being cared for by staff who had not had learning and development to enable them to fulfil the requirements of their role.

Care records held in the office and in people’s homes were incomplete and did not include relevant health information for example allergies, names of GPs were found to be missing and there was no list of current medication in the support plan. There was some evidence of consent for issues such as medicines administration from the local authority; we questioned the viability of the agency’s consent forms and mental capacity assessments which had been ticked as being completed. There was no evidence of a mental capacity assessment form or who had completed the assessment. The service was not working within the legal requirements of the Mental Capacity Act 2005 (MCA).

We saw from care records that some reviews of care had taken place. These were basic and lacked detail. Care plans were not person-centred and did not include a range of health and personal information. Assessments were not thorough and the registered manager had not listened to people’s preferred preference of a male or female carer.

Confidential information was not locked away safely in the office. Information was stored in boxes around the ground floor of the office.

There was a service user guide which should have been given to all people who used the service and/or their relatives. There was no evidence seen in the care files in people’s homes to show this had been received.

There was a complaints procedure in place. The service had received a number of complaints, some had been responded to, however there were no records of discussions with staff concerned. There was no monitoring of complaints by the registered manager that would enable them to identify trends and patterns and address the complaints accordingly.

There was an out of hour’s service for people who used the service and staff could also access help and guidance if they required it via the out of hour’s number.

Staff meetings were held but there was no evidence of the registered manager’s input at these meetings and staff attendance was low. There was no information in the Alexis Careworker Handbook regarding team meetings and the expectation of staff attendance. There was no system in place to evidence how information from these meetings was cascaded to staff.

There was a lack of quality monitoring and assessment of the service. We saw some telephone monitoring calls had taken place and some staff had received spot checks. These were basic checklist and there was no evidence to show how any actions from the spot checks had been addressed.

Recent information/reviews seen in some people’s homes was still being recorded on Carewatch paperwork. The registered manager informed us in writing that as from 14 January 2017 that all Alexios paperwork work would be in place within the next three months.

Accidents and incidents were not recorded appropriately or monitored by the registered manager. There was only one staff incident recorded in the accident and incident file.

Providers are required by law to notify the CQC of certain events in the service such as medications errors, safeguarding and other serious concerns. The CQC had not been notified of all such incidents.

Policies and procedures were held electronically, we were informed by the manager that these were under review and it was the intention to have a hard backed copy of the policies in the office.

The recruitment process was sufficient and suitable checks had been completed to help ensure that staff were suitable to work with vulnerable people.

Staff supervision sessions were now being completed. Staff who had been at the company for a number of years confirmed they had never an annual appraisal. The overall rating for this service is ‘Inadequate’ and 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.

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.