Archived: De Vere Care - Ealing

Updated 30 August 2018

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 comprehensive inspection took place on 16 July 2018 and was announced. We gave the service two working days’ notice as the location provided a service to people in their own homes and we needed to confirm someone would be available when we inspected.

The inspection was conducted by two inspectors.

Prior to the inspection, the provider completed 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 also looked at the information we held on the service including notifications of significant events and safeguarding. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about. We contacted the local authority’s safeguarding and commissioning teams to gather information about their views of the service.

During the inspection we spoke with the operations officer, the monitoring officer, the care co-ordinator and one care worker. We viewed the care records of six people using the service, the employment files for six care workers which included recruitment records, supervision and appraisals and we looked at training records for all staff. We also viewed the provider’s checks and audits to monitor the quality of the service provided to people. After the inspection visit we spoke with eight people using the service, two relatives and three care workers.

Updated 30 August 2018

This comprehensive inspection took place on 16 July 2018 and was announced. We gave the service two working days’ notice as the location provided a service to people in their own homes and we needed to confirm someone would be available when we inspected.

The last inspection took place in January 2018. The service was rated requires improvement overall, and in the key questions of ‘Is the service Safe, Effective, Responsive and Well Led?’. The key question of “Is the service Caring” was rated good. We found five breaches of regulations relating to consent to care and treatment, safe care and treatment, receiving and acting on complaints, good governance and staffing. We served warning notices on the provider in relation to complaints, good governance and staffing. We asked the provider to make the necessary improvements by 10 March 2018. At this inspection we found the provider had not made sufficient improvements and had not been able to fully meet the regulations. In addition, we found two further breaches of regulations.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, some living with the experience of dementia, people with learning disabilities and people with mental health needs. People’s care was funded by the local authority or privately. At the time of our inspection twenty people were using the service. Not everyone using De Vere Care received the regulated activity of personal care; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had a registered manager, but they were on long term leave and the provider had not made arrangements for an interim registered manager. 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.

During the inspection we found that risk assessments and risk management plans were not always robust enough to minimise risks to people and others. This meant the provider was not assessing, monitoring and mitigating risks to people to help minimise their exposure to the risk of harm. Incidents and accidents were not always recorded, for example, when care workers missed calls. This meant the provider was not always acting to minimise risks to peoples’ safety and well being

Medicines management was inconsistent including care workers not recording when they supported people to take their medicines and the failure to use medicines administration records (MAR) to record the administration of prescribed topical creams. In addition, the medicines policy had not been appropriately updated to provide effective guidance and the audits did not always identify discrepancies to help ensure people always received their medicines in a safe way. Furthermore, not all care workers had up to date medicines training or medicines competency testing to make sure they could support people with their medicines safely.

Safe recruitment procedures were not always followed to ensure care workers were suitable to work with people. Training, supervisions and appraisals were not up to date which meant care workers did not always receive the support they required to develop their professional skills and knowledge.

Where people lacked the mental capacity to consent to specific decisions, the provider did not always follow the principles of the Mental Capacity Act 2005 (MCA). Nor did care workers have a good understanding of the MCA.

Care workers were not always adequately deployed to ensure that calls took place and that care workers stayed the length of time as planned and agreed with people using the service.

The monitoring officer and the care co-ordinator were available to care workers and listened to their concerns and tried to address these. However, we saw complaints were not always being recorded, investigated and followed up in a timely manner and care workers were not made accountable for their actions that resulted in a complaint.

Care plans were not always robust or detailed enough in their guidance and in some cases, were not person centred.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, these were not always effective because of the lack of improvements and to an extent to the deterioration in the quality of the service since our last inspection.

The provider had an infection control policy in place but not all staff had undertaken training in this area to help protect people against the risks of the spread of infection.

We saw there were procedures for reporting and investigating allegations of abuse and whistle blowing. Staff we spoke with knew how to respond to safeguarding concerns.

People’s nutritional needs and dietary requirements were assessed and care workers knew how to support people to maintain good health.

People’s needs had been assessed prior to starting with the service and care plans included people’s likes and dislikes. However, people and their families were not consulted about end of life care.

We found seven breaches of regulations in relation to person-centred care, fit and proper persons employed, consent to care and treatment, safe care and treatment, receiving and acting on complaints, good governance and staffing. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.