22 October and 2 November 2015
During a routine inspection
The inspection took place between 22 October 2015 and 2 November 2015. We gave 48 hours’ notice of our intention to visit Mears Care - Fareham to make sure people we needed to speak with were available.
Mears Care – Fareham provides personal care services for people in their own homes in the Fareham, Gosport, Havant and Petersfield areas of Hampshire. Following a new contract with Hampshire County Council, the service had grown rapidly in the six months before our inspection. The number of people using the service had increased from less than 100 to almost 300 and the number of hours of support provided had more than quadrupled. Most of this growth was achieved by the transfer of care packages and staff from other providers.
There was a registered manager in post. 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.
During the period of service expansion, the provider had failed consistently to deploy sufficient numbers of suitable staff to support people according to their needs and preference. Evidence of employees’ suitability to work in a care setting in people’s homes was missing from a number of staff files. Processes designed to protect people from the risk of abuse and improper treatment were not carried out effectively. There were concerns about care workers’ practice and record keeping when supporting people with their medication.
The provider had failed to support staff by means of suitable training and supervision to carry out their duties to the required standard. A plan was in place to provide remedial training and identify new training needs. Staff took steps to make sure people consented to their care and support. The registered manager was aware of their legal responsibilities where people lacked capacity to make certain decisions. Most people had a good experience where care workers were responsible for making sure they had a healthy diet and where care workers needed to contact other healthcare providers for them. However a small number of people raised concerns in these areas.
During the period of transition of care packages from other providers, temporary care workers had not always been able to establish friendly, caring relationships with people. Where people had regular care workers they found they took steps to preserve people’s independence, dignity and privacy. They listened to people’s wishes and preferences about how they liked to be supported.
People’s assessments and care plans were not always completed to the required standard or reviewed and updated regularly. They did not always contain the information needed to make sure people’s needs were met and their preferences taken into account. The service had received a large number of complaints about the service people received. There had been a backlog in handling these due to the shortage of trained staff.
The registered manager had identified areas for improvement from complaints, supervisions and spot checks. They had an improvement plan in place, but at the time of our inspection they had just started to implement it so no improvements were yet in place. The transfer of care packages and staff from other providers had not gone smoothly, which resulted in poor communication between staff and between staff and people using the service. Records relating to people’s care and the management of the service were not always of the necessary quality and staff records were not always maintained in an orderly way.
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 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 found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Two of the breaches were concerned with the same regulation. You can see what action we told the provider to take at the end of the full version of this report.