Archived: Equinox Personal Care Service

At our last inspection on 16 June 2016, we found significant shortfalls in the care provided to people. We identified breaches of regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to a lack of person centred care, a lack of risk assessments to ensure safe care and treatment, good medicines management, inadequate provision of staff appraisals and a lack of auditing processes to ensure good governance and overall management of the service provided. We were not satisfied that care and treatment was being provided safely.

Following our last inspection, we were significantly concerned around the breaches of regulations 9 and 17. This related to ensuring that care provided was person centred and overall good governance of the service. We took enforcement action and issued two warning notices. A warning notice is a type of enforcement action that sets out what was found at the inspection and requires the provider to make adequate and swift changes in order to meet the regulations. At this inspection we found that the provider had met the requirements of the enforcement action.

The provider was also placed into special measures. Special measures are designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Its purpose is to ensure that inadequate care significantly improves and provides a clear timeframe within which the provider must improve the quality of care they provide. When a provider is placed into special measures, the CQC will re-inspect within six months.

This inspection was carried out within the six-month time frame to check if improvements to the quality of care had been implemented.

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. The registered manager was present during the inspection.

At our last inspection, we found that the provider was not adequately assessing and mitigating known risks for people. At this inspection, we found that although the majority of risks to people had been assessed appropriately, we found that the provider had not adequately addressed some known risks. Some of these risks were significant.

Not all staff had received an appraisal despite this being identified at our last inspection. However, staff had regular supervision that helped identify training needs and improve the quality of care.

Staff were aware of the difference between promoting and administering medicines. Medicines were managed safely.

Since the last inspection, the provider had brought in a training company to undertake staff training. Numerous training sessions had been provided and there was a plan in place for when staff required refresher training. Staff training was updated regularly and monitored by the registered manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People told us that they felt safe and well supported by staff. We saw positive and friendly interactions between staff and people.

Care plans were person centred and reflected individual’s preferences. People told us that they were involved in planning their care and that the service acted on their wishes.

There was a complaints procedure and people were aware of how to make a complaint.

Services that have been given a rating following an inspection are legally obliged to display their rating on their website, if they have one, and at the registered location where care is provided. The service was displaying its rating provided by the Care Quality Commission at the last inspection on its website and in the office.

At this inspection, we found breaches of regulations 12 and 18 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 the report.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

This was the first inspection of this service since they registered with the Care Quality Commission (CQC) in June 2015.

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. The registered manager was not present during the inspection.

Medicines were not always accurately recorded on the Medicine Administration Records (MAR). The registered manager did not complete medicines audits. Staff had received training on medicines administration.

Risk assessments were often a tick box format and did not give staff guidance on how to mitigate risks. Risk assessments failed to provide staff with appropriate information with regards to the people they were taking care of.

Staff had not received an appraisal. Staff did receive supervision. However, this was not documented.

Audits on any aspect of the service were not completed. There was no management oversight of quality assurance.

Care plans were not person centred and did not state people’s likes, dislikes or how they wanted their care to be provided. Care plans were brief, often several sentences and did not provide staff with an appropriate level of knowledge to be able to work with people and meet their needs.

People were not involved in decisions about their care. People were not consulted around creating their care plan. People and staff that worked with the people had not signed their care plans.

Procedures relating to safeguarding people from harm were in place. However, staff were not always aware of what safeguarding was or who to report it to if people were at risk of harm.

Staff had not received training around the Mental Capacity Act 2005 (MCA). Some staff had an understanding of the systems in place to protect people who could not make decisions outlined in the Mental Capacity Act 2005 (MCA). However, other staff were unaware of how the MCA would impact on the people that they worked with.

There were no systems in place to monitor missed visits.

People received continuity of care from regular care staff. The provider always tried to ensure that the same care workers looked after people. This promoted good working relationships with people who used the service.

People said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

There was a complaints procedure in place and people were given copies of the procedure giving guidance on how to complain when they began using the service.

The service operated an on-call system for any issues that arose out of hours.

We identified breaches of regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. We will publish what action we have taken at a later date.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special Measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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.