81 Wood Lane

81 Wood Lane is a domiciliary service providing personal care to three people at the time of the inspection.

People’s experience of using this service and what we found

Whilst we noted improvement in the systems around medicine management, further improvement was needed around the records of medicines given on an ‘as required’ basis. Additionally, further improvement was needed to ensure all risks to the person were clearly documented in people’s care plans and risk assessments.

There remained a lack of a formalised structure to enable new staff to be inducted into the service, supervised regularly and their competence reviewed.

Some improvement had been made to the systems that monitored the safety in the service. However, further improvement was needed to ensure these systems became effective at identifying concerns. This would enable the provider to have full oversight of the quality of people’s care

People were supported by staff who understood how to recognise and escalate safeguarding concerns should they have any. Improvements had been made to the recruitment systems in place.

People told us that staff had the necessary skills to support them safely. Staff had received training in most of people’s individual support needs.

People had received support with their healthcare needs and the provider worked in conjunction with a number of healthcare professionals to ensure people received continuity of care.

We received positive feedback from the people who received care. Improvements had been made in seeking feedback from people who received support from the service.

Staff knew the people they were supporting well and felt supported 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 and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 9 December 2021) and there were breaches of regulation relating to safe recruitment practices, supporting people safely, ensuring staff were inducted and supervised appropriately and in the monitoring of the service. We placed conditions on the providers registration that required them to send CQC monthly reports on key areas.

At this inspection enough improvement had been made to ensure staff were recruited safely and that people received safe care and the provider was no longer in breach of these regulations (Regulation 12 Safe Care and Treatment and Regulation 19 Fit and Proper Persons Employed). However, insufficient improvement had been made in ensuring staff were inducted and supervised appropriately and in the monitoring of the service and the provider remains in breach of these regulations (Regulation 18 Staffing and Regulation 17 Good Governance.)

This service has been in Special Measures since 9 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of the report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Inadequate to Requires Improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 81 Wood Lane on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a continued breach relating to the governance and oversight at the service (Regulation 17 Good Governance) and ensuring staff are appropriately inducted and supervised (Regulation 18 Staffing). We will continue to monitor the improvement within the service through existing conditions we have placed on the providers registration. This includes sending us monthly reports of action the provider has taken to make improvements within the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

81 Wood Lane is a domiciliary care agency providing personal care to people in their own homes. The service was supporting three people, with personal care at the time of our inspection.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Some records were not available when requested at the time of the inspection at the office. This was due to documents such as care plans and risk assessments not being in place for people using the service.

There was a lack of provider oversight which meant risks to people’s safety had not been identified and responded to appropriately. Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm. The lack of systems in place had failed to identify the areas for improvement found at this inspection including the care planning, risk assessments, safe recruitment processes and safe administration of medication.

Care plans were not in place for known health conditions to enable staff to have the information they needed to mitigate risk and meet or respond to people’s needs.

People were supported by a staff team who told us they understood how to protect them from abuse. Staff also understood how to protect people from harm such as injury, accident and wounds. However, the provider had failed to ensure all staff members had received up to date training. This placed people at risk from potential abuse and harm or injury.

People we spoke with said they felt safe and were very happy with the support they received.

Medication administration records (MAR) did not include the current list of medications prescribed for people using the service, such as creams. This meant care staff did not have accurate records to refer to, ensuring they were giving the correct cream, to the correct area of the body, at the correct time.

Staff were not always recruited safely. Safe recruitment practices were not followed and this placed people at risk of harm due to police checks not being carried out prior to employment commencing or suitable references obtained.

Additional audits needed to be implemented to provide clear and robust information and evidence of outcomes for people.

Systems and process which were in place were not robust to protect people from potential harm.

Staff we spoke to told us they understood their roles and responsibilities and felt supported by the management.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

This service was registered with us on 08 June 2020 and this is the first inspection.

Why we inspected

This was a planned inspection based on the registration.

We reviewed the information we held about the service.

The overall rating for the service following the first inspection is Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report to see what actions we have asked the provider to take.

Enforcement

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, good governance, staffing and fit and proper persons employed.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.