11 December 2017
During a routine inspection
Prior to our inspection we received some information of concern from local authorities commissioning people’s care. These concerns related to poor handling of complaints, safeguarding matters and service issues, poor quality of care records, ineffective quality monitoring, including missed and late visits and high staff turnover. We looked into these concerns during this inspection. The local authorities that commissioned the provider’s services were working with them to support them to make improvements. The provider had deployed their head of quality and regional quality manager to lead on devising and delivering an improvement plan that had been created in consultation with local authorities. As a result of implementing this plan, the provider was in the process of completing a backlog of investigations in relation to safeguarding matters and complaints. The local authority had implemented a voluntary stay on further care packages until the provider had secured the required improvements to the service.
Safeguarding adults from abuse procedures were in place and care workers understood how to safeguard people they supported. Care workers had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.
At the time of our inspection there was no registered manager at the service. 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 previous manager had left the service and a new manager had recently been appointed and was working at the service when we visited. They were in the process of submitting their application to be the registered manager to the CQC.
Risk assessments and support plans contained some information for staff, but we saw examples of incomplete records and therefore could not be assured that people were protected from avoidable harm. Care records also lacked information about people’s health conditions and their mental health needs.
Care workers were provided with appropriate training to help them carry out their duties. However, there had been a delay in care workers receiving supervision and appraisals of their performance.
Complaints were not investigated and responded to in a timely manner. The provider had a system of audit to identify and manage quality performance issues and risks. However, due to the departure of several key staff members within a short period of time, these had not been appropriately managed for a period of approximately two months. The provider’s systems for learning and making improvements when things went wrong had not been effectively implemented due to these staffing issues.
There was an adequate system for administering medicines safely. Care workers recorded any medicines that were administered and these records were required to be audited by the care worker’s supervisor on a monthly basis. Although there had been a delay in the return of these records to the office, the senior management team had conducted a recent in-depth review of records and taken action to rectify known issues.
Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. People’s support plans included mental capacity assessments and where necessary recorded decisions in people’s best interests in consultation with their relatives.
Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way. Care records contained a good level of detail about people’s individual needs and preferences.
People we spoke with told us they were involved in decisions about their care and how their needs were met. However, some people told us they were seen by different care workers and this had hindered their ability to develop a good relationship.
Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. However, care workers had not received regular supervisions and appraisals.
People were supported with their nutritional needs where this formed part of their package of care. Care records contained a good level of information about people’s dietary needs.
The provider had a clear vision and credible strategy to make improvements and deliver high-quality care and support. The provider needed more time to implement this strategy in order to embed the required improvements. We saw evidence that feedback had been obtained by people using the service and the provider was working to deal with reported issues.
During this inspection we found breaches of regulations in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.