We carried out an announced comprehensive inspection of this service on 6 October 2016 and breaches of legal requirements were found. 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 inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found that improvements had been made in relation to two of the four previous breaches, so those regulations were no longer being breached. However, we identified two continued breaches and one additional breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. You can see what action we told the provider to take at the back of the full version of the report.
During this inspection the service demonstrated to us that some improvements have been made and it is no longer rated as inadequate overall however one of the key questions still has a rating of inadequate. Therefore, this service is still 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 office inspection took place on 26 April 2017, with follow up phone calls to people, relatives and staff following this. We gave the provider 48 hours’ notice. This was to ensure that someone would be available in the office as it is a domiciliary care service. At the time of our inspection there were approximately 47 people using the service with a range of support needs such as people living with dementia, physical disability and older people.
There was a Registered Manager in post at the time of our inspection. 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.
People were not always protected from alleged abuse as some concerns had not been reported to the management and the local safeguarding authority for them to look into.
Guidance was not always available for staff to follow to protect some people’s skin integrity.
People’s medicines were not always managed safely as there were not always instructions available for staff to follow and there were not always explanations when medicines had not been administered.
People were not always protected from the risk of cross infection/contamination. Infection control measures were not always in place.
Although training had been improved since our last inspection, more improvement was required, particularly regarding the identification of safeguarding concerns and specific health conditions.
The principles of the Mental Capacity Act 2005 (MCA) were not always followed as people who may not have had Lasting Power of Attorney (LPOA) were signing consent on behalf of people. However, mental capacity assessments were now being carried out to help determine if people had capacity to make decisions.
People told us they felt they were treated with dignity and respect. However, we received feedback that people preferred to have regular staff and this was not always being offered and people did not feel their care was as personalised with non-regular staff.
People told us they felt that their feedback was not always acted upon to make improvements to their experience of care.
People and relatives told us they knew how to complain and improvements had been made since our last inspection regarding responding to complaint. However, further improvements were still required as some people did not feel their feedback was being responded to and issues not always been resolved.
Audits were now being carried out and whilst some had identified issues, some actions had not been completed and further work was required to ensure the improvements continued
The registered manager had been submitting notifications about the service, which they are required to do.
People told us they felt safe and their relatives confirmed they felt their loved ones were safe when being supported by staff.
Guidance was in place for staff regarding moving and handling, which had not been in place previously. These matched what people and relatives told us and what staff were recording in care notes.
People, relatives and staff told us there were enough staff. Safe recruitment practices were in place and staff had appropriate checks prior to starting work to ensure they were suitable to work with people who use the service.
People were supported with their nutritional intake when necessary, although most people were supported by their loved ones.
People had access to health care services and were supported by staff where required. Changes in people’s health were also reported to relatives.
People, relatives and staff knew who the registered manager was and felt able to go to them with queries.