Background to this inspection
Updated
11 October 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by 3 inspectors and an Expert by Experience who made telephone calls to people and relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Adonai Healthcare Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. A new manager had been in post since January 2023 and had not submitted an application to register with CQC .
Notice of inspection
We gave the provider 24 hours notice of the inspection. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection.
Inspection activity started on 22 August 2023 and ended on 29 August 2023. We visited the location’s office on 22 August 2023 and 23 August 2023. We carried out calls with staff and relatives between 25 August 2023 and 29 August 2023.
What we did before the inspection
We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of monitoring activity that took place in March 2023 to help plan the inspection and inform our judgements. We reviewed information we had received about the service. We sought feedback from the local authority who commission the service. We used all this information to plan our inspection.
During the inspection
We spoke with 9 relatives and 3 people who used the service. We spoke with 6 staff, as well as the manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included 6 people's care records, risk assessments, daily records and health records. We also looked at 3 staff files including their recruitment and training records. We reviewed records relating to the management of the service, quality assurance records and a variety of policies and procedures implemented by the provider. We also looked at other records the provider kept, such as minutes of staff meetings and surveys people completed to share their views.
Updated
11 October 2023
About the service
Adonai Healthcare Services is a domiciliary care service providing personal care to adults aged 65 and over in the Medway area. At the time of our inspection there were 20 people receiving a service.
Not everyone who used the service received personal care. 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
A person said, “Yes, I am quite happy. They help me in and out of the shower.” A relative said, “We’ve had the agency since June 2023, and I’ve had a couple of concerns that I have spoken with the manager about. I do not think that some of the carers are dementia trained, and it’s a bit of a haphazard service for Dad. The carers are lovely, but they do miss things.” Although people told us they feel safe and comfortable with staff visiting them, we found that people were not always sufficiently protected from the risk of harm because care plans did not always give enough information to support people safely.
People did not have appropriate risk assessments in place and environmental safety assessments had not been completed. Medicines were not managed safely.
Staff had not always been recruited safely to ensure they were suitable to work with people they support. There was no evidence of lessons learned despite accidents occurring.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The provider failed to follow the principles of the Mental Capacity Act 2005. There was no evidence of people's consent or involvement in care decisions.
Staff knew people well but could not support them effectively because initial assessments were not completed by the provider prior to commencing care packages for people to ensure they could meet people’s needs. We made a recommendation about this.
The provider had a complaints policy that included information about how to make a complaint and what people could expect to happen if they raised a concern. However, this had not been followed.
The provider did not have systems in place to monitor or audit the quality of the care provided therefore could not drive improvements. Oversight and management of the service was not effective.
Staff training was not effective. People were not supported by staff who were skilled, trained and knowledgeable. Staff had not received all training relevant to meeting people's assessed needs.
Staff followed good infection control practices including wearing personal protective equipment when supporting people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 7 July 2022 and this is the first inspection.
Why we inspected
The inspection was prompted due to concerns received about staff deployment, people not receiving care to meet their assessed needs, dignity and respect, infection control and responding to complaints. A decision was made for us to inspect and examine those risks.
Enforcement
We have identified breaches in relation to risk management, medicines management, safe recruitment practice, staff deployment, mental capacity, person-centred care, dignity and respect, complaints management and quality monitoring at this inspection. We have made a recommendation on how the provider consider good practice guidance in relation to initial assessment of people’s care and support needs.
Please see the action we have told the provider to take at the end of this report. 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.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
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 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.