The Inspection took place between 2 and 10 May 2018 and it was unannounced. De Vere Care – Southend is a domiciliary care agency. This service provides personal care to people living in their own houses and flats. It provides a service to adults who may be living with dementia, a physical disability and/or mental health conditions.
At our previous inspection on 20 November 2017, we rated the service Good overall but needing improvement in Safe.
The registered manager left the service in November 2017 and although there was a manager in post they had not applied to be registered. 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.
At this inspection, we identified that the service failed to provide all the people it served with safe care and treatment. Staff have been continually paid late or incorrectly which had resulted in care workers and office staff resigning. People’s calls had been late, missed or shortened due to a lack of care workers. There had been a 39% reduction in staff since December 2017 and existing staff had been attempting to cover all of the necessary calls. Because of this people had missed their meals and medication placing them at risk of harm.
Recruitment practices required improvement to ensure that care workers were safe to work with vulnerable people. Although people had been protected against the risk of infection improvements were needed because requests for personal protective equipment, such as gloves, had been delayed.
Although care workers told us they felt supported and well trained, improvements were needed because they had not received supervision as often as required within the service’s own policy. Training records showed that care workers’ training had not always been updated regularly.
Where people had regular care workers, they were well supported to eat and drink and they felt they were kind, caring and compassionate and knew them well. However, some people had either missed their meals, or had them very late in the day due to missed and late calls. This placed them at risk of dehydration and/or poor nutritional intake. The recent staffing problems also meant that people without regular care workers often felt rushed despite their care workers kindness.
The manager had carried out monthly audits of systems and practices; however, improvements were needed as the action plans they devised did not include clear timescales for action to be taken.
The provider had not taken action to improve the situation therefore their lack of oversight, understanding and management of the service has had an impact on a large number of vulnerable people. The provider failed to identify and address concerns and breaches of regulatory requirements. This has led to risks to the quality of care and to people’s health and wellbeing.
There were policies and procedures in place for safeguarding people. Care workers were trained and knew how to apply the training, and safeguarding matters had been dealt with appropriately. Although people told us they felt safe with their care workers, the impact of missed and late calls had made some people feel unsafe.
Care workers had received health and safety training and had an understanding of how to manage risk. People’s care plans contained risk assessments and management plans. People’s needs had been fully assessed and their care plans reflected this. The service had regularly reviewed and updated care plans and risk assessments to ensure they continued to meet people’s needs.
People received appropriate healthcare support when needed. The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA) to ensure that people had as much choice and control over their lives as possible. Care workers had been trained and had an understanding of how to support people to make decisions.
People had been fully involved in the assessment and care planning process and their care plans met their needs. Complaints had been dealt with appropriately and were discussed at team meetings to enable lessons to be learnt.
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.”
The Commission took urgent action after the first day of inspection to ensure people remained safe, and were not placed at continued risk. We served an urgent notice of decision to impose a condition that the provider must not provide personal care to any new service user from De Vere Care - Southend without the prior written agreement of the Care Quality Commission.
You can see what action we told the provider to take at the back of the full version of the report.