Archived: Mears Care Torbay and Devon

Updated 22 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was 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 2 and 4 October 2018 and was carried out by two inspectors. We told the service the day before our visit that we would be coming because we wanted them to produce figures and reports we would need to look at during the inspection.

Before the inspection visit we looked at all the information we held about the service and information that that had been shared with us from the Local Authority. We also looked at the last inspection report and any notifications. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about.

During the inspection we met the executive director, operational manager, quality assurance manager, brokerage manager, two quality leads, the care lead and the senior co-ordinator. Following the inspection we spoke with the human resources TUPE transfer lead. We were contacted by four care staff who wanted to share their views and experiences. We spoke with three people who used the service and the relatives of three other people on the telephone.

We looked at the care records for five people who used the service and the records used by the provider to monitor care visits, the quality of the service and systems and processes.

Updated 22 November 2018

Mears Care Torbay and Devon is registered with the Care Quality Commission (CQC) to provide personal care to people living in their own homes. It provides a service to adults with a range of health and social care needs.

On 17 September 2018 the service took over the care visits of an agency that had closed down, this equated to 156 people having care visits. Prior to the transfer, Mears Care Ltd worked with Devon County Council and the provider of the agency that was closing, on a transition plan to ensure safe transfer.

At the time of the inspection and again following the inspection, we asked senior management how many people they now supported with personal care and how many care visits they carried out a week, including those people from the new contract. We did not receive this information.

There was no registered manager in post; however, the operations manager had made an application to register with us but this was withdrawn on 13 September 2018. 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 service had been inspected on three previous occasions. In October 2016, the service was rated ‘Inadequate’ in all five key questions. We identified eight breaches of the Health and Social Care Act 2008 and associated regulations. The Care Quality Commission (CQC) took enforcement action against Mears Care Limited and imposed a condition on the provider's registration.

We inspected this service again in June 2017 when we found improvements had been made. No breaches of the Health and Social Care Act 2008 Regulations were identified, and the service was removed from special measures. During this inspection we rated the service ‘Requires Improvement’ overall as improvements were still needed to protect the rights of people who lacked the mental capacity to consent to care and treatment as well as to the service's quality monitoring systems.

The service was last inspected between October and December 2017 in response to concerns raised that the service was not able to provide care visits to people as planned. The service was rated as ‘Requires Improvement’. We identified one breach of the Health and Social Care Regulations (Regulated Activities) 2014 and made one recommendation for improvement.

On Monday 24 September 2018 we received information of concern from two relatives and one member of staff that a significant number of people were not receiving care visits as planned. We were also made aware that the local authority, Devon County Council, had been working with the service in crisis management over the weekend, as there were multiple missed care visits. We undertook this focused inspection on 2 and 4 October 2018 to look into the concerns raised.

At this inspection, we found serious shortfalls in the management of risk, insufficient staffing levels and leadership and governance. The overall rating for this service has deteriorated from 'Requires Improvement' to 'Inadequate' and the service is therefore placed 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.

The leadership and management of the service was inadequate. We looked at how the provider had managed the transfer arrangements of the care packages between themselves and the care provider who had ceased business. We found governance systems to ensure smooth transfer between providers, safety and continuity of care and consistency of staff had not been effective in ensuring people received safe care that met their needs.

We found there was a lack of management oversight and the systems and processes in place had not ensured that people received their care visits as planned and this had placed some people at risk of avoidable harm. We found the service’s business continuity plan, although instigated, had been ineffective in managing/mitigating risks associated with staffing levels. Concerns from senior staff about insufficient staffing numbers prior to the transfer of care packages, had not been escalated to higher management level at Mears Care Ltd or to the local authority.

People were placed at risk because the provider did not ensure there were enough staff available at all times to deliver planned care. We found the systems and processes followed during the transfer of care packages, were not robust or managed effectively. This meant systems had not identified that a significant number of staff were not transferring to Mears Care Ltd and the provider did not have a robust contingency plan in place. This resulted in 91 missed visits between 17 and 23 September 2018, which placed people at risk of avoidable harm.

People were at risk because the provider had not made every reasonable effort to gather information about potential employees transferring from the other care provider to ensure they were of good character and had the necessary employment checks in place such as police checks.

People did not always receive safe care and support. Some people were left for long periods of time without their basic care needs being met. For example, some people were left in wet beds or soiled pads because they could not get out of bed or to the toilet without help. One person told us that they were in a wet bed from 7am until the carer visited at 2.30pm. They told us they had no breakfast or medicines as they relied on carers to get them out of bed. They told us, “I felt helpless, very unsafe, distressed and vulnerable.”

Other people were at risk of not receiving sufficient nutrition and hydration. Some people relied on care staff to prepare their meals and drinks, where care visits were missed people went without food and drink as they were unable to prepare this for themselves.

People were not always protected from the risk of harm. Where people had been identified as needing two staff to support them safely, this was not always being provided due to the reduced staffing levels. This resulted in care that was unsafe, placed the person and staff at risk, and did not meet the person’s assessed needs. One person told us they felt unsafe.

People did not always receive their medicines as prescribed. Where visits had been missed or were late, people had not received their medicines which put them at risk of harm. For example, people taking medicines to manage their diabetes or heart conditions. People taking medicines for pain control were subjected to avoidable pain and discomfort due to missed or late visits.

Arrangements in place to review people’s care needs prior to the transfer, had failed to identify that 12 people had not had their needs assessed and did not have a care plan in place. This meant staff had not been provided with sufficient information to meet these people’s needs.

People and staff were not always given the information they needed and there was a lack of communication. People and relatives told us they were not kept informed about any changes to their care. We heard of many examples of people phoning the office and not receiving a response. This lack of communication had left people angry, frustrated and extremely anxious as they did not know from one day to the next who was coming or if anyone would turn up. One person said, “No one has called to say sorry or explain why this happened.”

Staff we spoke with were passionate about their work and knew changes needed to be made but were extremely upset and frustrated by the organisation and how the transfer had been managed. Staff told us they did not feel listened to and when staff had raised concerns these were not taken seriously, and action was not taken. A relative told us, “Staff have been marvellous, but they have too much work to do. One young carer, who was very apologetic for being so late, broke down in tears.”