We carried out this inspection on 17, 18 and 19 October 2017. This inspection was announced, which meant the provider was given 48 hours’ notice of our inspection visit. This was because the location provides a domiciliary care service and we needed to be sure that someone would be available to meet with us.Samfos Health is a domiciliary care agency registered to provide personal care to people in their own homes. At the time of this inspection Samfos Health was supporting 46 people.
There was a registered manager employed at the service. 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.
Not all care staff we spoke with could remember receiving training in protecting vulnerable adults or children from abuse. There was no record of any member of staff undertaking this training. However, care staff were aware of what actions to take if they suspected someone was being abused.
Effective systems were not in place to ensure that people were supported to take their medicines safely.
Care records did not fully reflect whether a person had capacity to make decisions about their care and treatment. Care staff were not aware of the principles of the Mental Capacity Act 2005 (MCA). However, they were able to tell us about the importance of involving people in decision making.
People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible. However, the policies and systems in the service did not support this practice.
Staff did not receive regular supervision, annual appraisals, or appropriate training to support them to carry out their jobs effectively.
People’s care records were not person-centred and were not regularly reviewed. This meant the information as how to best support people to meet their needs was incomplete. There was no evidence that people’s personal preferences were taken into account when care records were reviewed.
Some of the care records we looked at included risk assessments, which identified any risks to the person’s health and wellbeing. However, there was no evidence of any of the risk assessments being updated following a review or change in the person’s needs. This meant the information regarding each risk may no longer be relevant to the person.
The service had an up to date complaints and compliments policy and procedure. However, some people told us they weren’t satisfied with the responses they had received when they had complained. Complaints were not investigated in a timely way. No records were kept of complaints.
The views of people and their relatives were not regularly obtained, and were not recorded.
The service had up to date policies and procedures which reflected current legislation and good practice guidance. However, some of these needed further development to include local guidance specific to the service. Care staff did not have access to the latest versions of the policies to keep their knowledge up to date.
There was no evidence of regular quality audits being undertaken to ensure safe practice and identify any improvements required.
Safe staff recruitment procedures were adhered to.
People were supported to eat and drink to maintain a balanced diet.
People were treated with dignity and respect and their privacy was protected. All the people and relatives we spoke with made positive comments about the care provided by staff.
During this inspection we found the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 13, Safeguarding service users from abuse and improper treatment; Regulation 12, Safe care and treatment; Regulation 18, Staffing; Regulation 11, Need for consent; Regulation 9, Person-centred care; Regulation 17, Good governance; Regulation 16, Receiving and acting on complaints; Regulation 20A, Requirement as to display of performance assessments.
We also found omissions in the reporting of incidents to CQC as required by regulations which was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.
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.