Background to this inspection
Updated
10 June 2021
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
The inspection was carried out by a single inspector.
Service and Service type
This service is a domiciliary care agency. It provides personal care and nursing 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
We gave the service a four days’ notice of the inspection. We needed to be sure that the provider or registered manager would be in the office to support the inspection as it is a small service and they are sometimes directly involved in people’s care.
What we did before the inspection
Before the inspection we reviewed the information we held about the service. This included the action plan they had sent us following the last inspection. We spoke with the local authority safeguarding and commissioning teams about the service.
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.
We used all of this information to plan our inspection.
During the inspection-
The inspector visited the office on 16 April 2021 and spoke with the registered manager, and the office manager and looked at records held by the service. They requested additional records to be provided for review. Following the office visit they spoke with one person using the service and a relative of another person on 19 April 2021. They also spoke with three nurses and two care workers by phone on the 19, 20 and 21 April 2020.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
10 June 2021
Slade Healthcare Limited is a domiciliary care agency providing personal and nursing care to people in their own homes.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection the registered manager told us three people were using the service; two of whom received personal care.
People’s experience of using this service and what we found
People and their families were complimentary about the care and support provided. However, we found issues we had identified at the last inspection in relation to medicines, the assessment of risk including infection risk, staff recruitment and the oversight and management of the service had not all been addressed. The enforcement notice served following the last inspection had not been met.
There was an absence of effective systems to monitor the quality and safety of the service and it was not evident that some potential risks were safely managed, or that the provider identified any learning and made improvements to the service. There were repeat breaches of regulations. There was an absence of accurate records of people’s care or records related to the management of the service.
We found no evidence of harm, but we could not be assured that these areas of the service were being managed safely. This placed people at possible risk of harm or unsafe care. The provider and registered manager did not demonstrate they understood the requirements of their roles and the regulations related to the carrying out of the regulated activity.
There was an absence of a recorded assessment of people’s needs or detailed personalised care plan. Staff had received training and support, but records were not fully maintained to evidence the support and training provided to new staff or the more specialised aspects of people’s care. Records in relation to contact with health professionals or peoples’ communication needs were not well maintained.
People said they were supported with their nutritional needs where this was a part of their plan of care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.
People and their families commented that staff were kind and caring and that staff treated them with respect and dignity. Staff were able to tell us how they respected people’s diverse needs and encouraged them to be as independent as possible. The service had a complaints policy and process in place to manage any concerns raised by people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
This service was registered with us on 17 May 2019 and this is the first comprehensive inspection. We carried out a targeted inspection of the service on 27 October 2020 following receipt of information raising concerns about specific aspects of the service provision. We found breaches of regulations 12,17 and 19. We took enforcement action and served a warning notice.
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection not enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
We carried out this comprehensive inspection to determine whether the warning notice we previously served in relation to Regulations 12,17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to provide the first rating for this service.
You can read the report from our last inspection, by selecting the ‘all reports’ link for Slade Healthcare Limited on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so
We have identified breaches in relation to the assessment of risk, management of medicines, staff recruitment and the way the service is managed.
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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.
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 may 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.