This inspection took place on 18, 23 and 25 September 2015 and was announced. We last inspected the service on 13 August 2013. We found they were meeting all the legal requirements we inspected against.
Westhome Care Services Limited provides personal care for people living in their own homes. At the time of the inspection they were supporting 131 people (some of whom were living with dementia) living across Sunderland and South Tyneside.
The service had a registered manager. 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.
Medicine administration records were not always completed. This meant that it was not always possible to see whether medicines had been administered. People’s care plans did not list their medicines. It was not always clear from the plans what kind of support they needed with their medicines. There was no guidance for staff to follow when supporting people with ‘when required’ medicines.
Risks to people’s health were not always fully assessed. Some care plans referred to people’s particular health needs but did not set out how they should be mitigated. Where risks were identified for staff to monitor, there was no evidence that this was being done. We did not see any evidence of initial moving and handling assessments being completed.
There was no safeguarding policy in place. It was not clear how people were made aware of how to report possible concerns. Staff were trained in safeguarding and had a good working knowledge of possible types of abuse and how to respond. Safeguarding incidents were investigated and action plans were created but it was not always clear that remedial action had been taken.
The recruitment policy specified that staff had to obtain a Disclosure and Barring Service (DBS) check and provide two references before beginning work. We saw that staff started before these were in place. When staff started in post prior to receipt of satisfactory employment checks, they were always supervised or risk assessed.
People told us that there were enough staff employed to support them. There was not always continuity of staff and they were sometimes late. People said that when appointments were missed or staff were running late communication from the service was poor. Staff told us that they had enough time to support people.
Staff received mandatory training in areas such as moving and handling, emergency first aid, infection control and safeguarding. We saw that some staff were overdue mandatory training or had never completed it. Staff did not receive training in specialist areas of care, such as pressure care or skin integrity.
The service had a policy of annual appraisals and supervisions of staff every four months. We saw that staff did not always receive them. Where supervisions had taken place and staff had raised an issue remedial action was not always taken. Staff told us that they felt confident to raise issues with management.
People said they felt supported with their food and nutrition. Where people had specialist dietary requirements these were recorded, but we saw that they were not always acted on.
There was no evidence that capacity assessments had taken place or any formal record of decisions being made in people’s best interest.
Some people’s care plans showed that they were receiving support in specialist areas from external professionals such as occupational therapists. However, some people with the same support needs had not been referred to such professionals.
People told us that not all staff were caring. They told us that they were often supported by staff they had not met before, which made them feel that staff did not know them or how to support them. People said that when appointments were missed or staff were running late communication from the service was poor.
Care plans were not always written in a person-centred way. It was not always clear from care plans what level of support people needed or had requested. Not all care plans contained information about people’s background or personal preferences.
The service had a complaints policy, but this only related to written complaints. There were no records to show that investigations of complaints occurred or remedial action taken. Where people told us that they had raised concerns with the service this had not been recorded.
Audits of care plans relied on people, some of whom were living with dementia, filling in a questionnaire to tell the service that their support needs had changed. People were supposed to be sent a questionnaire twice a year, but we saw that some people’s audit questionnaires were overdue.
We were told that staff meetings took place but that the last one was held in June 2014. It was not clear how the service sought feedback from staff who had not received supervisions or appraisals, or how any feedback given was used to improve the service.
The registered manager did not always understand their responsibilities to make notifications to the CQC. We saw that we had not been told about some relevant matters.
You can see what action we told the provider to take at the back of the full version of the report.
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.