Archived: Roses Socialcare Ltd

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.

We carried out the inspection with our five questions in mind; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service caring?

Staff told us they enjoyed caring for people and felt they had enough time at each visit to do this well, without feeling rushed. One staff member told us: 'You can't put a time on care'. Staff we spoke with told us they cared for people with the same caring qualities as they would hope to receive themselves or for their families.

We saw in people's care plans there was a reminder that people's dignity, respect and human rights must be promoted at all times.

Is the service responsive?

Relatives told us their family member's interests were considered as well as their physical care needs. This meant staff supported people with their social needs as well as carrying out physical care tasks.

We saw from people's care plans, visits were scheduled to be of no less than half an hour in order to be able to respond to people's needs.

Is the service safe?

Safeguarding procedures were robust and staff told us how they would safeguard the people they supported. We were told there had been no accidents or incidents, but staff were aware of how to record and report these. We were unable to speak with people who used the service because of their complex needs. However, we spoke with their relatives, who told us they felt their family members were safe when being supported by staff.

The care manager took responsibility for ensuring staff rotas were in place to meet people's needs. She explained staff skills and experience were taken into account when matching staff to people's needs, so that people's needs were properly met.

We saw recruitment practice was safe because all staff were vetted and fully inducted before they cared for people. Staff were informed about policies and procedures that helped them to keep people safe.

Is the service effective?

The registered manager told us assessments were always done thoroughly and in person to make sure people's needs were fully identified before agreeing to provide care and support. Relatives we spoke with told us assessment visits were very thorough and this reassured them proper care would be provided to their family member.

Relatives told us they knew what was in their family member's care records and they had been involved in discussions about the care so they knew it reflected the person's needs.

Is the service well led?

The registered manager had taken the concerns raised at the last inspection seriously and put measures in place to improve the service. We saw this impacted positively on staff knowledge of the service and of their own responsibilities and roles. Staff told us they thought the service was well run and they felt supported in their work and encouraged to develop their skills.

The registered manager had improved the quality assurance system and employed a care manager to help oversee practice. Roles within the team were being developed to ensure staff had ownership of their work and to work effectively as a team.

Feedback was sought from people who used the service and from staff, all of which was positive and complimentary of how the service was run.

We visited the office and spoke with the manager, four staff, and one work experience trainee. We spoke with one person's relative because the person was unable to communicate with us. We also saw and spoke with two people who used the service because they visited the community centre at the time of our visit.

We saw staff interacted with people in a kind and caring way. They spoke respectfully with people and were attentive to their needs.

We looked at people's care plans and found these lacked important information and were not fully updated. We saw people had not signed their care plans.

Staff we spoke with said they had not received thorough enough induction and lacked knowledge of the policies and procedures. We found staff had some knowledge of safeguarding adults although were not clear of the procedure to ensure people were protected from harm.

We looked at three staff files. One file we saw had incomplete information and we could not find sufficient evidence this staff member had been suitably vetted.

We looked at systems for monitoring and assessing the quality of the provision and found these were not robust enough to ensure the service was delivered effectively.