Archived: Alexios

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.

The last inspection took place on 06 May 2014 as part of the Care Quality Commission (CQC) new methodology. The service was found to be meeting all the requirements reviewed.

Carewatch – Bolton provides care and support to people that enables them to remain in their own homes. Care is provided to people who require help with personal care and daily living tasks such as shopping and with the preparation of meals.

At the time of the inspection there was a registered manager in post. The registered manager was also the nominated individual for the company. 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.

The service has had numerous changes in registered manager’s position in the last two years. Some staff were unaware who was in charge of running the service at the time of the inspection.

A basic system was in place to audit how the service was operating. Improvements were needed in the quality of the monitoring. There was no evidence to show that the registered manager had been involved in the oversight of the service.

People we spoke with told us they felt safe with the staff that visited and supported them.

Both people using the service and relatives we spoke with said that staff had the knowledge and skills to do a good job.

People were very positive about the caring and compassionate nature of the staff that supported them. They told us that their privacy and dignity was maintained when being supported with personal care tasks. People we spoke with also told us they were always asked for their consent before care staff carried out any particular care or support tasks.

The service had failed to protect people against the risks associated with the safe management of medication. We also found gaps in the recording on food and fluid charts.

We found inconsistency in care files with the completion and updating of records.

Some of the wording on the daily records recorded by staff was inappropriate and not respectful. This was discussed with senior staff during the inspection. The care plans we looked at were not person centred.

Risk assessments had been completed when the care package started. We found that these had not been reviewed in a timely manner.

The agency had corporate policies and procedures were in place. These were electronically held. There was no evidence to demonstrate that staff had read any of the policies.

There was a complaints policy in place, however not all complaints had not been responded to appropriately.

Comments received from people who used the service, relatives and staff felt the office staff were not always helpful and approachable, messages were not communicated to the appropriate person and that the on call system was not always available when required.

Comments by some staff raised concerns about a ‘bullying’ culture from some office staff if they questioned their work load. This sometimes resulted in care staff having their next day’s calls taken off them and these calls were passed to other carers resulting in extra pressure on them.

Staff were not receiving regular supervisions or appraisals. Care staff spoken with said team meetings had not taken place.

We found Carewatch Bolton ensured people who used the service had been provided with information about the services provided. We looked at some care records and other information the agency is required to keep.

People we spoke with were complimentary about the agency and the staff who visited them. We were told:

'The girls are great, I have no concerns'

'The office staff are very helpful'.

'The carers that come to visit my X are very good, and offer me great support'.

We spoke with staff who told us:

'The in house training is good; however I would like to do an NVQ (National Vocational Qualification'.

'I have no problems with the number of visits I have in day, but sometimes it's difficult to get to the next call on time due to the distance we have to travel'.

'The office makes sure we always have a supply of protective, disposable gloves and aprons'.