The inspection took place on the 17 and 20 August 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We wanted to be sure that someone would be in to speak with us and that we could meet with people using the service. Olive Home Care and Support is a domiciliary care agency registered to provide personal care and support services to a range of people living with physical disabilities, mental health needs and people living with dementia. The service provides personal care to people living in their own houses and flats in the community. At the time of our inspection the service was supporting 20 people.
The service had a 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.
At the last inspection on 1 August 2017, the service was rated Requires Improvement. This is the second time the service has been rated ‘Requires Improvement.’ This was because the provider had not fully ensured staff were suitably trained and deployed to meet people’s needs in a way that met their needs.
At this inspection we identified further areas of practice that required improvement, including breaches of regulation in relation to safe recruitment, safeguarding, safe care and treatment and quality assurance and governance.
Practice around the administration of medicines was not consistently safe. Staff were trained and assessed as competent to administer medicines. However, practice around the administration and recording was not consistently safe. There was a lack of guidance for staff on how daily and ‘as required’ medicines should be given. People’s prescribed medicines were not always given in the way the prescriber intended and the governance of medicines was not robust enough to ensure that shortfalls were addressed without delay.
People and their relatives had made a number of ongoing complaints in relation to delayed and missed calls since the last inspection. Social care professionals and two local authority professionals had worked closely with the provider to reduce the levels of missed calls. During this time people were at an increased risk of not having their care needs and preferences met including, access to their medicines, food, personal care needs and feeling secure. One person noted in a complaint to the provider that a delay of two hours in their night time call had left them feeling unsafe. Records demonstrated that although some improvements had been made, that not all calls were being made in a timely way that promoted people’s needs being met.
Recruitment procedures had not ensured that staff were safe to work with vulnerable people, as the registered manager and provider had not always robustly carried out their own recruitment and safeguarding policies.
People were not always protected from the risk of harm, abuse or potential abuse. Staff could tell us about different types of abuse and were confident the registered manager would take concerns seriously. However, on at least two occasions, peoples’ wellbeing was not promoted as the registered manager did not effectively identify, or act on, evidence that abuse may have occurred. They also failed to notify the CQC of these incidents and the local safeguarding bodies, or do so in a timely way. Where accident and incidents had been identified and records completed, action were not always fully documented to reduce the risk of reoccurrence and effectively mitigate the risk of further injuries.
Quality assurance systems failed to monitor the overall quality of the service and to identify short falls. The registered manager and provider recorded information relating to quality assurance areas, however they failed to scrutinise the information and design effective responses to address higher risk shortfalls including medicines management and missed calls without delay.
The registered manager did not fully understand their responsibilities in relation to their registration with the Care Quality Commission (CQC). The provider had not consistently submitted notifications to the CQC as is required by law.
People did not always receive personalised care and support. The changing needs of people were not always considered and consistently supported by detailed care plans. Communication at the service was not consistently effective. The electronic monitoring systems was still being embedded and records were not consistently completed by staff.
People told us that staff were caring. One person told us, “They are very nice. I can’t say more than that.” We observed people and staff interacting in a comfortable manner.
In July 2018 the provider reduced the number of people they supported to 20 and limited their geographical area of the service. People and relatives who were currently using the service told us that they had recently seen improvements in the service. One relative told us “The service has improved recently, more regular carers, before it wasn’t the case, it’s improved a bit in the last month.”
The registered manager recognised the principles of Accessible Information Standard and the benefits of services recording and meeting people’s ongoing information and communication needs.
People were supported in line with the principles of the Mental Capacity Act (MCA) 2005. People felt that they could make some choices and relative felt they were treated as individuals and that their privacy was respected. One person told us, “Yes, they do respect my privacy. I have a key safe so they let themselves in and they always call out and knock on my door before coming in.”
The registered manager and staff worked closely with health professionals. Staff were aware of the importance of people remaining as independent as possible and people told us they were supported to do as much as they could for themselves. One person told us, “I can move around with my trolley with a little tray on it. I’m able to move things from one place to another. It’s very useful.”
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version on the 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.