Background to this inspection
Updated
24 July 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 one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own home
The service did not have a manager registered with the Care Quality Commission (CQC). Registration with the CQC means 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 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection.
The inspection activity started on 14 June 2021 and ended on 25 June 2021. We visited the office on 15 and 24 June 2021.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require provides 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 reviewed information we had received about the service since the service was registered. We sought feedback from the local authority who commissioned with the service. We used all of this information to plan our inspection.
During the inspection
We spoke with seven family members about their experience of the care provided. We spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. The manager, care co-ordinator and senior team leader. We contacted 12 members of staff by e-mail to seek their views, and four members of staff responded.
We reviewed a range of records. This included two people’s care records and medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including monitoring of quality and risk, policies and procedures and minutes of meetings.
After the inspection
We continued to seek clarification from the provider as to their plans going forward for the service.
Updated
24 July 2021
About the service
Wellbeing and Support Limited is a domiciliary care service. The service provides care and support to people living in their own homes. During the period of the inspection the number of people using the service decreased from eight to two.
People’s experience of using this service and what we found
People’s safety, health and welfare had been put at risk due to poor governance, and their being not enough staff to meet people’s needs. This had resulted in people experiencing missed calls or calls at times which did not meet their needs. Family members and others had met the staffing shortfalls by providing personal care to their relatives. Family members spoke of poor communication, often being given short notice of there were not being enough staff to cover their relatives care calls.
Family members were aware of managerial and staffing difficulties and told us they had either secured or were in the process of securing alternative providers to meet the care needs of their relatives. In some instances, family members had been supported by office-based staff to identify alternative providers, and some spoke of support offered by commissioners.
The registered manager had terminated their employment in March 2021 and the service was initially managed by the nominated individual (The nominated individual is responsible for supervising the management of the service on behalf of the provider) who had submitted an application to register as manager with the Care Quality Commission (CQC). However, CQC have been unable to progress the application due to their unavailability. The nominated individual appointed an interim manager who had been in post for seven weeks at the time of the inspection.
The manager informed us their priority and focus had been in managing care calls to ensure people’s needs were met, as much as possible. They spoke of ongoing staff resignations, which had impacted on their ability to meet people’s needs. The manager confirmed people, or their family members were in the process of identifying alternative providers. The number of people using the service, and the number of staff employed decreased during the period of the inspection.
The provider had failed to ensure policies and procedures were followed, which included the quality and quality monitoring policy, complaints and medication policy. This meant opportunities to improve the service and people’s outcomes had been missed.
The providers approach to ongoing support and monitoring of staff was not consistent, which meant opportunities to drive improvement had been missed.
Potential risks to people’s safety had been assessed with regards to their individual needs and the environment in which care was to be provided. Care plans had been developed which provided information as to how risks were to be minimised.
People received support with their medicines. However, improvements were needed to medication records.
Family members and staff told us they would not recommend the service. Family members told us staff were king and caring where they had been supported by a consistent group of staff, positive relationships had developed.
Staff recruitment processes ensured staff were suitable to work with people. Staff had undergone training at the commencement of their employment.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 11/11/2019 and this is the first inspection.
The inspection was prompted in part due to concerns received that there were not enough staff employed to ensure people’s packages of care were provided, which had resulted in late or missed calls. We also received information that staff were not always wearing personal protective equipment (PPE). A decision was made for us to inspect and examine those risks.
You can see what action we have asked the provider to take at the end of this full report.
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 not enough staff being employed to meet people’s needs and poor governance and leadership.
Please see the action we have told the provider to take at the end of this report.
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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.