Archived: Roses Socialcare Ltd

Updated 22 February 2017

We undertook an unannounced inspection of Roses Socialcare Ltd on 6 and 12 May 2016. This inspection was undertaken to ensure the concerns we had at our previous inspection had been addressed. We returned to Roses Socialcare Limited 9 June 2016 to see whether the actions which had been identified by the registered provider had been taken in line with the action plan they sent to us following our concerns.

The inspection team consisted of two adult social care inspectors. During our inspection we spoke with four people who used the service and their families, two members of care staff and the registered manager. Prior to our inspection we had received information of significant concern from a number of whistle blowers. This was in relation to concerns about the recruitment process which was in place and care calls being missed. There were also concerns raised about the standard of the training some care staff had received before they began work. The service was last inspected in October 2015, and was found to require improvement in safe, effective, responsive and well-led. At this time there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We spoke with other agencies who worked with the service to gather further information; these included local authority social work teams.

During our inspection we looked at the care records of 11 people who used the service. We visited the homes of four of the people whose care records we had sampled. We looked at the staff files for 19 staff and a variety of other records including, complaints and concerns, safeguarding, policies and procedures and auditing of the service.

Updated 22 February 2017

The inspection took place 6 and 12 May 2016 and was unannounced. We returned to Roses Socialcare Limited 9 June 2016 to check whether actions the registered provider had told us would be undertaken by that date had been completed. We found there was very little evidence of improvement and the actions which had been completed were not to the required standard. There was a registered manager, but they were on a leave of absence and were not present during the inspection in May however they were present during our visit 9 June 2016. There was a manager who was responsible for the day to day operation of the service; however they were only present during the later afternoon of the inspection.

Roses Social Care is a domiciliary care agency who provides care and support to people in their own homes. The people who were being supported had a range of needs including living with dementia, terminal illness and older people who required support to remain independent in their homes. At the time of this inspection 23 people were receiving care and support from Roses Social Care.

The service was previously inspected in October 2015, at this time the service was found to be requiring improvement and there were breaches identified in relation to person centred care, need for consent and good governance. At this inspection we found there had been a significant deterioration of the quality and safety of the service.

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.

Staff demonstrated a basic understanding of the principles of protecting vulnerable people and keeping them safe. Staff were able to tell us who they would report concerns to and describe the types of abuse they would look out for.

There were very few risk assessments in place. Those which were in place were not risk specific and did not show what the risks were and what measures needed to be in place to minimise those risks and promote people’s safety.

There were no records available to demonstrate the registered provider recorded accidents and incidents, therefore there was no evidence these matters were investigated and ‘lessons learnt’ taken from them where appropriate.

Staff recruitment was disorganised and we found the processes which were in place were not followed which led to unsafe recruitment practices. These included not seeking references from previous employers, not gaining a full employment history including accounting for gaps in employment, and we found instances where a person had been allowed to work before their disclosure and barring service (DBS) check had been received and other instances where staff had failed to disclose criminal convictions on their applications which showed on their DBS checks. These staff had been allowed to continue working without any risk assessments and there was no evidence investigations had been carried out into their dishonesty during the recruitment process.

Staff were not adequately trained or skilled to carry out their roles. This was particularly in relation to the use of equipment to assist people who were unable to move themselves without this. There was no evidence that appraisals were carried out and there had been no recent supervision of staff. Quality checks were not carried out regularly to observe the practice of staff working with people in their own homes.

There were not sufficient staff to safely meet the needs of people who used the service. This had led to missed and late calls.

There was clear evidence of instances where family carers had been asked to help to use equipment because only one care staff was available for a call which required two care staff.

There were instances where missed and late calls had not been appropriately reported or investigated, to the relevant authorities. This meant there was no learning from the issues which had led to the calls to be missed.

The information in care plans was unclear and conflicting about the level of assistance people required to take their medicines safely. There was evidence staff were assisting people to take medicines when there was no evidence to support they should be giving this support. There were no processes in place for medication administration records to be brought into the office and checked to identify any errors or issues with prescribed medicines.

There was no evidence that people had been asked for or had given their consent to the care which was being given. There were also no mental capacity assessments in place to show whether people had capacity to make their own decisions about their care or whether they needed this to be carried out in their best interests.

Care plans were not in place for all the people who used the service in the office. There were some cases where there were summary care plans in place which were short task based summaries of what should be carried out during each planned visit. These were not adequate to meet people’s needs and were not reviewed to reflect changes to people’s needs.

There had been no complaints recorded since our last inspection, despite people who used the service telling us they had raised complaints and concerns with the office team.

There was no leadership evident in the service. The manager who was in post told us they spent a significant amount of their time carrying out care calls as there were not enough staff to cover them. This meant there was no management presence and no contact with the manager whilst they were delivering care to people who used the service.

There were no processes or systems in place to monitor the quality and safety of the service. There was no oversight available to the registered provider to be able to judge the service was being well run and the quality and safety of people was assured.

In total we found breaches of eight Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.