Background to this inspection
Updated
11 March 2017
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.
The inspection took place on 14 September 2016 and 10 October 2016 and was unannounced. We received concerning information which prompted us to inspect the service.
The inspection team consisted of one adult social care inspector. We gathered information before the inspection from the information we hold within CQC and from the local authority.
The methods used as part of the inspection were talking with people using the service, their relatives, interviewing staff, observation and reviews of records.
We viewed four staff files, four care plans and associated records such as daily records and Medicine Administration Records (MARs) for two people who were receiving assistance with their medication.
We spoke with eight members of staff, four people who use the service and two relatives. We contacted the Commissioners of the service.
The provider sent us with an action plan and details of staff deployed/recruited to alleviate the staffing problems impacting on people receiving care.
Updated
11 March 2017
An urgent responsive inspection was undertaken on 14 September and 10 October 2016 following concerns from a member of the public and the manager. There were breaches of regulations from the last inspection which had not been met. This meant that not enough improvements had been made which is a legal requirement.
The service is an Extra Care Living Scheme which means people were receiving care in their own homes in a complex which was staffed 24 hours per day. There were 47 people receiving a service at the time of our inspection. There was a scheme manager who was responsible for day to day management duties and a registered manager in post. The registered manager in post was also a registered manager at another location.
A registered manager is 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.
We found that the service were still in Breach of Regulation 12 2 (g) Medicines as gaps were still found on Medicine Administration Records (MARs) on our recent inspection. Therefore it wasn’t clear if people had received their medicines as prescribed.
There was a breach of Regulation 19 on the last inspection. Out of the four staff files we looked at they included a reference from a family friend or neighbour and therefore, remained in breach of this regulation.
There was a breach of Regulation 17 on the last inspection due to audit systems not highlighting the issues found on inspection. We found the service remained in breach of this regulation as their quality control systems were still not effective and had not identified the concerns we found or appropriately addressed the concerns when they became apparent.
There were insufficient staffing levels to meet the needs of the people needing care. There was evidence of clashes on the rotas were staff were being required to visit different people at the same time.
Risks were not always identified with a risk assessment for staff to follow and risk assessments were not always being updated often enough.
The service was seeking consent at the point of the care package commencing but we could not see how the service was obtaining consent for times of calls. We were concerned the service was not always following Mental Capacity Act 2005 legislation and there was no record of a mental capacity assessment or best interest discussion having taken place for one person who did not have the ability to provide informed consent.
We were concerned people were not always receiving care calls at meal times due to a missed visit or a late visit. Therefore, we could not be sure people were having enough to eat or drink.
Staff were receiving an induction and training however we raised concern with the provider that we had not seen certificates to confirm staff had completed mental capacity training. We were provided with certificates following the inspection for two out of the four staff whos files we had checked. We could not see a system of competency checks being undertaken following training being completed.
Some staff were receiving supervision but not all staff. We did not see any appraisals being undertaken in the staff files we viewed. We were informed by the provider following the inspection that a small number of staff had appraisals due in August 2016 and November 2016 which had not yet been undertaken at the time of inspection. This was due to a new manager starting and there needed to be a period of familiarising themselves with the staff members before it was deemed appropriate for appraisals to be undertaken.
Staff were observed speaking with people in a caring way and were passionate about wanting to be able to deliver an improved caring service for people.
Staff morale was low due to low staffing numbers impacting on care delivery for people. Service users and staff were not always being listened to by the service.
Assessments were being completed and people's signatures were being obtained to agree to their plan of care but the care plans were lacking in detail such as the call times being agreed with the person.
All the care plans we viewed contained some person centred information but pertinent information such as the person’s preferred times to receive their care was missing. We viewed one person’s care plan who was living with dementia and found their plan of care was not detailed enough for staff to know how to provide them with person centred care.
We found a complaints system in place but not all concerns raised were being followed up. This was highlighted within an internal audit completed by the service.
There were ineffective governance and quality assurance systems in place to prevent a staffing crisis from impacting on service users and staff. Communication systems within the hierarchy of management had broken down.
The audits being undertaken were highlighting concerns such as the potential for some staff to be working over 60 hours per week but no checks were then in place to identify if this was occurring to ensure there was no negative impact on the quality of the care being delivered.
The rating of the last CQC inspection was not being displayed for members of the public to read it and to be aware of the overall rating of the service.
The overall rating for this service is 'Inadequate' and the service therefore is 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.