Archived: Sevacare - Haringey

Updated 10 August 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 24 and 30 June 2015 and was unannounced. The inspection team consisted of four inspectors and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. Their involvement was limited to phoning people, to ask about their experience of the care services provided.

Before the inspection visit we reviewed the information we held about the service including notifications, information from the local authority, any contact we had had with members of the public about this service, and other information the provider had sent us.

During this inspection we spoke with 30 people who use the service and six relatives to obtain their views on the service provision. This included visiting three people in their homes with their permission. We also spoke with 17 care workers.

During the inspection visits we spoke with the manager, the area manager, the regional director and eight staff members. We looked at the care records of 20 people using the service, 12 people’s medicines administration records, and the personnel records of 12 care staff. We also looked at electronic care planning and delivery records, and various other records used for the purpose of managing the service. The manager provided us with further documents at our request after the inspection visits.

Updated 10 August 2015

Sevacare (UK) Limited is a national provider of care and support services to people in their own homes. ‘Sevacare – Haringey’ provides personal care to people of any age living in Haringey who need care due to ill health or disability.

We carried out a comprehensive inspection of this service on 14 and 15 December 2014. We found seven breaches of legal requirements, which put people using the service at significant risk of receiving inappropriate or unsafe care. You can read the report of this inspection, by selecting the 'all reports' link for this service on our website at www.cqc.org.uk

We took enforcement action against the registered persons, including cancelling the registration of the previous manager of the service, and proposing to remove the location ‘Sevacare – Haringey’ from the registration of the provider, Sevacare (UK) Limited.

We undertook this unannounced comprehensive inspection, of 24 and 30 June 2015, to check on the progress the provider had made to address our concerns from the previous inspection, and to check on the standard of care people using the service were receiving. At the time of this inspection the agency was providing a care service to over 270 people in their own homes, which meant just under 4000 hours of service per week. Since our last inspection, the provider had moved its service for people in another local authority to a different location.

Whilst we found evidence to demonstrate that some of our concerns had been addressed, we found breaches of three legal requirements. This continued to put people using the service at unnecessary risk of receiving inappropriate or unsafe care.

We continued to find instances where people’s scheduled visits did not occur as planned, because the visits were either missed or shorter than planned for. There was evidence of insufficient staff travel time in-between visits to people. Where people had electronic call-monitoring systems to check on the times of staff entering and leaving their home, these were not consistently used. People’s care needs and preferences were not always met in these instances.

We continued to find that people were not being supported to manage their medicines safely. This was because medicine records had not been consistently filled in to demonstrate that people had been supported to take their medicines as prescribed.

There remained shortfalls in the effectiveness of the provider’s governance of the service. Whilst a number of audit tools were now being used effectively to address potential service risks, weekly reports to senior managers continued to omit information on missed visits and safeguarding cases. Checks of care delivery records continued not to identify risks around medicines management. Where a person had requested a care worker to be excluded from visiting them, or a safeguarding case had recommended an exclusion, we found that systems to ensure this were not effective.

Records were now provided to us in full when we requested them. However, we still found some records were not accurate or up-to-date. This undermined, for example, explanations provided by the service into other concerns of ours, because there were sometimes no records to support what we were being told. Whilst there was evidence of complaints and safeguarding matters being attended to, records did not always demonstrate effective operation of these processes.

Staff now had up-to-date training, supervision and appraisal. However, we were not assured that these processes were being productively used to support staff to provide appropriate care for people, because, for example, some parts of the appraisal were not filled in. Most of the recorded content on care workers’ supervision forms was similar, with little specific to each individual care worker’s needs.

Staff were aware of the practical applications of the Mental Capacity Act 2005, however, this Act was inconsistently applied within care documentation.

However, a number of improvements had occurred since our last inspection. There was improved feedback about the approach of care workers. Most people using the service valued the relationships they had with staff and expressed satisfaction with the care they received. We found that people now received a consistent set of care workers with whom they developed positive, caring relationships.

There was no registered manager in post on the dates of the inspection visits. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. A new manager had been appointed since our last inspection, whom we met during this inspection. Their registration as manager was completed whilst this report was being drafted. There was positive feedback from people using the service and staff about the new manager’s approach. Everyone had had a face-to-face review of their care needs, care plans were up-to-date, and there was improved feedback from people and their representatives about receiving personalised care.

People’s formal complaints were now being responded to promptly, with apologies for service shortfalls where appropriate and action plans being communicated to complainants. Expressions of dissatisfaction were also being addressed.

The service was taking steps to protect people from the risk of abuse. Allegations of abuse were now being notified to us, and the service was alerting the local safeguarding authority about safeguarding concerns that care staff were raising, to help protect people.

Appropriate recruitment checks took place before new staff started work. Disciplinary processes were now being used to help ensure that established staff were suitable to work with people.

People received sufficient support with food and drink, and appropriate support to maintain good health, including through referrals to community healthcare professionals.

We found overall that people using the service continued to be at some risk of receiving inappropriate or unsafe care. We found three breaches 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.

Following this inspection we continued with our enforcement action. The action we took was to serve a notice proposing to remove the location ‘Sevacare – Haringey’ from the registration of the provider, Sevacare (UK) Limited.

Due process was followed which meant that the Care Quality Commission removed the location ‘Sevacare – Haringey’ from the registration of the provider, Sevacare (UK) Limited, on 4 April 2016.