Archived: Temp Exchange Limited

Previously we carried out an announced comprehensive inspection of this service on 9, 10, 12, 13 and 19 November 2015. The overall rating for this provider was judged as ‘Inadequate’ and the service was placed into ‘Special Measures’ by the Care Quality Commission. As a result of this a Notice of Decision was served whereby the provider was not able to undertake any further care packages without the written agreement of the Care Quality Commission. The provider shared with us a revised action plan on 4 June 2016 detailing what they would do to meet legal requirements. In addition to this we met with the provider on 10 June 2016 to discuss their action plan and our future regulatory arrangements. Whilst significant progress had been met to meet the majority of regulatory requirements minor improvements were still required in relation to the provider’s arrangements for recruitment and staff induction.

The service did not have a registered manager in post. At the time of the inspection the provider had employed a manager and they subsequently confirmed that an application to be formally registered with the Care Quality Commission had been submitted and they were expecting confirmation of their ‘fit person’ interview. Following the inspection the Care Quality Commission were made aware that the proposed manager was no longer employed by the organisation. 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 taken steps to address the shortfalls found at the last inspection in November 2015. This included implementing systems and arrangements to monitor the quality and safety of the service. However, improvements were required to ensure that changes and improvements are embedded and sustained over time to ensure people are provided with a consistently safe quality service. Recruitment practices required further review and strengthening so as to ensure that the provider’s arrangements were safe and met future compliance with this regulation. Additionally, although there was information to suggest that staff employed at the service had received an appropriate induction, there was a lack of supporting documentation to confirm if these arrangements were robust.

Appropriate arrangements were in place to assess and manage risks to people’s safety. Risks for people had been identified or anticipated and there were sufficient staff available to meet people’s care and support needs at this time. People’s healthcare needs were identified to ensure that they received suitable care and support from staff. People where appropriate were supported to have their nutritional and hydration needs met. People confirmed that there had not been any missed calls and staff stayed for the full amount of time allocated to ensure they received care and support as they should.

People spoke positively about the way staff treated them and reported that they received appropriate care. Staff demonstrated a good knowledge and understanding of the people they cared for and supported. People told us that their personal care and support was provided in a way which maintained their privacy and dignity. We found that people’s care plans reflected current information to guide staff on the most appropriate care and support people required to meet their needs.

Staff had received applicable training to enable them to deliver care and support to people who used the service. Formal arrangements were in place to ensure that staff were supported and received formal supervision and ‘spot visits’.

Complaint procedures were in place to enable people using the service, staff and others to raise concerns. People were aware of these and stated if required they felt confident to raise issues.

The inspection was completed on 9, 10, 12, 13 and 19 November 2015, this included visits to the provider’s registered location and visiting people and speaking with people over these dates. At the time of the inspection there were 91 people who used the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service.

A registered manager was not 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.

Risks to people’s safety were not managed appropriately. Risks for people had not been assessed adequately or actioned effectively and people were at risk of receiving care and treatment that was unsafe and did not meet their needs.

The recruitment process was inadequate and unsafe as recruitment checks had not been completed on all staff before they commenced working at the service.

Not all staff had received appropriate and up-to-date training to enable them to deliver care and support to people who used the service safely and to an appropriate standard. Formal arrangements were not in place to ensure that newly employed staff received a comprehensive induction, regular supervision or appraisal.

Information relating to people’s ability to consent to their care and support was not recorded and some staff members’ understanding relating to the Mental Capacity Act 2005 required improvement.

People’s care plans did not reflect current information to guide staff on the most appropriate care people required to meet their needs. Care plans had not always been updated and were absent from people’s homes in some instances. Concerns and complaints raised by people were not recorded, investigated or actioned appropriately.

People reported late and missed calls which the provider had failed to monitor. Late and missed calls impacted negatively on people’s needs such as medication regimes. Staff did not record medication administration appropriately.

Although people stated that they felt safe and cared for with some staff, they also reported that some staff did not respect them and did not always uphold their privacy and dignity. Furthermore, staff were not trained effectively in order to recognise people at risk of abuse or harm and did not demonstrate that they would take action accordingly so as to safeguard the people they supported.

There was a lack of oversight on the provider’s behalf regarding the implementation of quality monitoring and assurance systems. Quality assurance systems were not effective and failed to demonstrate how the service was identifying areas for improvement and taking the appropriate actions.