Background to this inspection
Updated
22 December 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 5 and 13 November 2015 and was announced. We gave the provider 48 hours’ notice to give them time to become available for the inspection. It was undertaken by a single inspector. This inspection was completed to check that improvements to meet legal requirements planned by the registered provider after our comprehensive inspection on 29 July 2015 had been made. We inspected the service against four of the five questions we ask about services: is the service safe? Is the service effective? Is the service responsive? Is the service well-led?
Before our inspection we reviewed other information we held about the provider such as feedback from members of the public.
During the inspection we spoke with the director, the manager and a care coordinator. We looked at seven people’s care records, medicines records, nine care workers recruitment documents and records relating to the management of the service.
After the inspection we spoke with two people using the service and two relatives, the local authority a relative of a person who stopped using the service in August 2015 and a representative of a person who stopped using the service recently. We also spoke with three care workers and a care co-ordinator.
Updated
22 December 2015
This inspection took place on 5 and 13 November 2015 and was announced. We gave the provider 48 hours’ notice to give them time to become available for the inspection. When we last visited the service on 29 July 2015 we found the service was not meeting regulations relating to safe care and treatment, complaints, good governance, recruitment, consent and notification of other incidents. We served warning notices in relation to safe care and treatment, complaints, good governance and consent in which we asked the provider to make the necessary improvements to meet the breaches of regulations by 8 October 2015. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.
We undertook this focused inspection to check the provider had followed their action plan and to confirm that they now met legal requirements and had addressed the areas where improvement was required. We found the provider had not taken all the necessary action to improve the service in respect of the breaches we found which meant they were still in breach of regulations.
This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Peel House on our website at www.cqc.org.uk.
The overall rating for this provider at the 29 July 2015 inspection was ‘Inadequate’ and remains ‘inadequate’ from this inspection. This means that it remains in ‘Special measures’. The purpose of special measures is to ensure that providers found to be providing inadequate care significantly improve. These also 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. They also 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.
Peel House, also known as Thames Healthcare Service Ltd, provides personal care to people with a range of needs, in particular older people. The service provides regular support for people in their own homes. There were 22 people using the service at the time of our inspection.
The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager was working at the service when we visited the agency but they have since resigned from their post.
Medicines management was not safe. The provider did not have robust systems to ensure people received their medicines as prescribed as staff often did not follow prescribers’ instructions. They were therefore not protecting people against the risks associated with medicines.
The provider had not yet reviewed all people’s risk assessments. We found risk assessments had not been reviewed for over a year for one person. This meant risks reflecting this person’s condition might not have been identified so appropriate plans were put in place to manage the risks. People’s backgrounds and aspirations were not always recorded in their care plans for staff to understand them better and to make sure care was tailored according to people’s needs.
Recruitment of staff remained unsafe. We found evidence the provider had employed several applicants without suitable employment references and had not carried out criminal records checks and had not verified if they had the right to work in the UK. We reported these concerns to the UK Borders Agency (UKBA). We also reported concerns about payroll management to the Department of Work and Pensions (DWP). We shared our concerns about medicines management and unsafe recruitment practices with the local authority safeguarding team.
The provider and staff did not demonstrate that they fully understood and met the requirements of the Mental Capacity Act 2005 in relation to people’s mental capacity to make decisions, so people’s rights were fully protected. They had not carried out mental capacity assessments when they suspected a person lacked capacity in relation to a particular decision and did not understand the need for best interest’s decision meetings when people were found to lack capacity to make decisions about their care and support.
The provider had not taken the action they set out in their action plan in order to meet legal requirements in relation to complaints. Complaints were not always recorded clearly with the provider’s response and the outcome to show complaints were dealt with appropriately.
The service was not well-led. The provider had inadequate processes in place to assess, monitor and improve the service. There were no effective audits in place relating to staff recruitment as the provider had not identified the recruitment failings we picked up. Although the provider had introduced audits to check medicines records, these audits were inadequate as they repeatedly failed to identify errors in medicines administration. The provider had also not identified failings in risk assessment processes and care planning, even though they had recently carried out reviews of people’s care records. They were unable to make the necessary improvements we had asked them to make to meet legal requirements.
The provider did not fulfil their roles and responsibilities as part of their registration with the CQC. We requested a number of documents which the provider was unable to show us. These included call monitoring records to show the provider checked people received their calls as agreed. In addition records of weekly calls office staff made to people to check they were satisfied with their care and monitoring of daily logs were not provided. Lastly, we requested policies in relation to medicines, complaints and recruitment which the provider did not give us.
The service still did not submit notifications to CQC as required by law, such as allegations of abuse and an incident involving the police.
We found continued breaches of regulations during this inspection relating to safe care and treatment, complaints, good governance, consent, recruitment and notification of other incidents. We imposed urgent conditions to address the concerns we had about medicines management and recruitment. This meant we told the provider to carry out a medicines audit to ensure people were receiving medicines as and when prescribed. In addition we asked the provider to audit all staff recruitment folders ensuring each contained information required by law. Because of the seriousness of our concerns about this provider and the inability they had shown to rectify these concerns we took further enforcement action. You can see more information about the enforcement action we have taken at the back of the main section of this report.