Archived: U5 Limited

Prior to our visit, we had received information of concern about the quality and safety of the service provided. This information prompted our visit. We gave the provider of the service short notice before our visit to ensure they would be available to participate in the inspection. 24 hours after we notified the provider of our intention to visit on the 31 March 2016, they contacted The Commission and informed us that in their own judgement the service they were delivered was inadequate and they intended to close the service at the end of their contract with the Local Authority. They said this was due to consistent staff shortages which had impacted on quality of the service provided. Our inspection of still went ahead and we carried out the inspection on the 31 March 2016, 1 and 29 April 2016.

There was a registered manager in post who participated in the inspection visit. 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’.

A senior manager had been employed by the provider to provide managerial support to the registered manager. Both the senior manager and the registered manager reported to three Directors of the service (the provider) in relation to how the service was managed. These Directors were present during the inspection and were involved in the day to day running of the service also. We liaised with the provider and senior manager for the majority of our inspection.

During this inspection, we found breaches of Regulations 9, 11,12, 13, 14, 16, 17, 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We looked at the care files belonging to 17 people who used the service. We found they did not adequately cover people’s needs and risks. They failed to provide clear information or guidance to staff in the provision of safe and appropriate care. This placed the person at risk of harm. Care plans were not personalised to people’s individual needs and preferences and staff lacked sufficient guidance on how to provide people with person centred care.

We found that where people had mental health conditions which may have impacted on their ability to consent to decisions about their care, their capacity had not been assessed in accordance with the Mental Capacity Act 2005. Staff had no guidance on how to support people with mental health needs and appropriate action had not been taken where people’s mental health impacted on the ability of staff to deliver their care.

We saw from people’s daily logs that they did not always received the care they needed at the required times or for the length of time that they had agreed. People regularly experienced visits that were too early, too late or missed altogether. Some people’s visits were not appropriately spaced, so that sometimes breakfast and lunch and lunch and tea times visits were only an hour or so apart. We did not find evidence that people’s needs were consistently followed up when visits were late or missed or evidence that the provider checked that people received the support they needed. People we spoke with confirmed this.

During the irregularity of visits, some people did not receive their medication at regular times. People’s medication administration charts showed gaps in the administration of medication that were unexplained and did not demonstrate that people always received the medication they needed or in a safe way.

People did not receive support with meal preparation to promote their nutritional health at consistent or appropriate times. Others went significant periods of time in between visits which compromised their personal care.

There was no evidence that the provider had checked on people’s welfare or reviewed their care to ensure that the support people received continued to be suitable for their needs. Where people’s support needs had changed, people’s care plans had not been updated. This placed people at risk of inappropriate or unsafe care.

There were no adequate staffing arrangements in place to enable the provider to be confident that people’s needs would be met. The provider was fully aware of the staff shortages but had taken no effective action to review people’s care to ensure that the number of staff employed could safely deliver the care required.

No action had been taken to monitor how many visits were too early, too late or missed altogether. When we looked at the visit records, we found staff were sometimes booked on more than one visit at any one time, meaning they were impossible to achieve. Despite this information being available, the provider had not utilised this information to plan staffing arrangements, to arrange agency cover or to mitigate any risks. This meant the provider failed to safeguard people from the risk of harm.

There were gaps in the training of some staff members and some training had not been updated since 2011 and 2012 which meant it could have been out of date. Staff lacked appropriate supervision in their job role and their skills and abilities had not been regularly evaluated by the provider to ensure they were competent to deliver care to people to an appropriate standard.

Staff were subject to pre-employment and criminal record checks prior to employment to ensure they were suitable to work with vulnerable people. People we spoke with told us that the staff who delivered the care were kind and caring and did their best.

We saw that the provider had a satisfactory complaint policy in place. We looked at the two complaint records the provider had on file. We found that they had been properly responded to but we found that other people’s concerns about their care had not been resolved or addressed.

For example, we saw that people’s views about the quality of the service had been sought by the provider by telephone survey. Over half of the people surveyed raised concerns about their care but there no evidence that any action had been taken to address their concerns and on the days we visited, people’s feedback remained the same.

Two people we spoke with and a relative told us that they had complained to the provider many times about the quality of the service and the care they received. One person “You may as well talk to the table”. Another said “The Company is terrible”.

There were no effective audits in place to check the quality and safety of the service. We found that the provider and the registered manager lacked the appropriate management skills and accountability for the quality and safety of the service. The provider had failed to ensure the registered manager and staff followed policies and procedures, failed to follow their own quality monitoring system, and had failed to take any action to protect people from risk.

During our visit on the 31 March and the 1 April 2016, we raised serious concerns with the provider about the safety of the service and asked them to refer the care of some of the people whose care file we looked at to the local authority safeguarding team to protect them from further risk. We also asked them to take appropriate action to mitigate any further risks to people’s health, safety and welfare. Despite this on our return to the service on the 29 April 2016, we found no effective action had been taken to address our concerns and ensure people were safe.

The overall rating for this provider is ‘Inadequate’. This means that it was placed into ‘Special measures’ by CQC. The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system

to ensure improvements are made.

- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their

registration.

Services placed in special measures are inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This leads to cancelling their registration or to varying the terms of their registration within six months if they do not improve. Such services are kept under review and if needed can be escalated to urgent enforcement action.

Where necessary, another inspection is conducted within a further six months, and if there is not enough improvement we would move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

However, after our visit on the 29 April 2016 and in conjunction with the Local Authority, the provider closed the service and people’s care was transferred over to an alternative home care provider. Due to the seriousness of our concerns, the closure of the service was brought forward by the provider in conjunction with the Local Authority and The Commission and occurred within five weeks of our initial visit. This meant that people were protected from any f

People's comments about the service included the following: 'I have the same carers and they're very efficient.', 'The two carers I have are brilliant, they know what I'm going to do next." and "The carers are very good to me. They couldn't do anything better, they do everything for me."

We also contacted relatives as part of our inspection. One relative told us that staff were punctual and reliable and the quality of the service was good.

We found that appropriate procedures were in place to the support people with managing their medication.

Staff felt well supported and appropriately trained. Communication across the staff team was reported to be good and staff were being provided with regular supervisions and team meetings.

The provider had a system in place for monitoring the quality of the service and this included asking people who used the service for their views.