Archived: De Vere Care - Milton Keynes

Updated 14 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is 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 20 and 22 September 2017 and was unannounced. The inspection was completed by four inspectors and one expert by experience that made telephone calls to people who use the service, their relatives and staff. An expert by experience is a person who has personal experience of using a service like this, or has experience of caring for someone who uses a service like this.

This inspection was completed in response to concerns we had received and therefore we did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the information we held about the service, including statutory notifications that the provider had sent us. A statutory notification provides information about important events which the provider is required to send us by law. We also contacted health and social care commissioners who place and monitor the care of people living in the home to identify if they had any information which may support our inspection.

During our inspection we spoke with six people who used the service, five relatives, eight members of care staff, the Care Coordinator and representatives of the provider.

We looked at care plan documentation relating to seven people, and five staff files. We also looked at other information related to the running of and the quality of the service. This included quality assurance audits, training information for care staff, staff duty rotas, meeting minutes and arrangements for managing complaints.

Updated 14 November 2017

This unannounced inspection took place on 20 and 22 September 2017. This service is a domiciliary care agency which supports people with their personal care needs in their own homes. At the time of our inspection 19 people were receiving care from De Vere Care – Milton Keynes.

There was not 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 provider had failed to deploy sufficient numbers of staff in order to meet the needs of people who used the service and failed to demonstrate a systematic approach in determining the number of staff required. People were not always cared for by staff that had the knowledge, skills, experience and support they needed to carry out their roles. Staff did not receive appropriate supervision or training to enable them to fulfil their responsibilities.

The service had been without a registered manager in post for four months and this lack of leadership had significantly impacted on the quality of care that people had received. The provider did not appear to be aware of the seriousness of their lack of oversight of people’s care and the significant risks this posed to the people relying upon the service for their care.

The systems in place monitoring planned care visits to people was inadequate. The service had a call monitoring system in place which could not be relied upon as an accurate reflection that people had received their planned care.

The provider did not have sufficient guidance for staff to follow to show how risks to people were mitigated and not all potential risks had been assessed.

There were not always appropriate arrangements in place for the management of medicines. There were occasions when people did not receive their prescribed medicines because the provider did not ensure there was enough adequately deployed staff to meet their needs.

There was poor monitoring of people’s nutritional and hydration needs which put people at risk. Records could not be relied upon as an accurate account of people’s food and fluid intake. There was lack of monitoring and oversight of people who were at risk of not eating or drinking enough.

The provider had not changed their practice in relation to issues raised in verbal complaints and actions had not been identified to prevent similar concerns being raised.

Providers are required by law to notify Care Quality Commission (CQC) of certain events in the service such as serious injuries and safeguarding concerns. Notifications had not been reported to the CQC.

People were supported by staff who were aware of the requirements of the Mental Capacity Act 2005. People and relatives told us staff gave them choices.

Staff understood people's needs. However care plans were not up to date to support staff in delivering safe care and support in accordance with people's individual needs.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the end of the inspection the provider informed us that they intended to close the service De Vere Care – Milton Keynes. They told us that they would work closely with the local authority to ensure that packages of care and support were provided by alternative agencies. The Care Quality Commission have received a notification from the provider to cancel their registration for this location.

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.