Background to this inspection
Updated
11 November 2017
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.
The inspection was carried out on 21, 22, 25, 26, 27 and 28 September 2017. The inspection was announced. The provider was given notice because the location provides a domiciliary care service and we needed to be sure that the registered manager was available. The inspection was carried out by three inspectors, an inspector assistant, a specialist professional advisor in governance and an expert by experience. Three inspectors visited the agency office on 21 September 2017. Two of these inspectors and a specialist advisor visited the office again on 27 September 2017. The inspector assistant and expert by experience made phone calls to people who used the service and relatives.
Before the inspection we reviewed the information we held about the service. This included looking at information we had received about the service and statutory notifications the registered manager had sent us. We also contacted the local authority contracts and safeguarding teams.
We asked the provider to complete 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. The provider returned the PIR and we took this into account when we made judgements in this report.
During our visits to the agency office on 21 and 27 September 2017 we spoke with the registered manager, the regional manager, an apprentice administrator, three care workers, a training officer and three care co-ordinators. We looked at the care records of 14 people who used the service, six staff recruitment files, training records and other records relating to the day to day running of the service.
On 22, 25, 26 and 28 September 2017 we spoke on the telephone with 17 people who used the service and/or their relatives. We also spoke with eight care staff.
Updated
11 November 2017
We inspected Ark Home Healthcare Halifax on 21, 22, 25, 26, 27 and 28 September 2017. We gave the provider short notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies to make sure the registered manager can be available. This was the first inspection of the service since the provider registered with the Care Quality Commission in May 2017.
Ark Home Healthcare Halifax is a domiciliary care agency which provides care and support services to people in their own homes. At the time of our inspection the service was providing support to 130 people in Calderdale, Kirklees and Wakefield.
There was a registered manager 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. The registered manager was present on both of the days we visited the agency's office.
In the three months prior to this inspection we received several concerns from relatives and staff about the care being provided to people. These related to people’s care needs not being met, poor medicine management, late and missed calls, poor communication, the attitude of some staff and the lack of training. As a result we made safeguarding referrals to the local authority and brought forward the inspection so we could assess the overall quality of the service and check the provider was meeting the legal requirements.
We found medicines were not managed safely as records were incomplete so we could not be assured people had received their medicines when they needed them.
We found there were not enough staff to meet people’s needs. Staff arrived late to people’s homes and did not stay for the allocated time.
Safeguarding incidents were not always recognised or dealt with appropriately. We saw some incidents had been investigated and referred to the local authority safeguarding team, however we found two incidents that had not been appropriately reported. Safeguarding referrals were made following the inspection.
There were inconsistencies in how risks to people were managed. We saw some records provided detailed information which showed how risks were assessed and mitigated, yet other risk assessments contained very little information.
Recruitment systems showed criminal record checks and references were obtained before employment commenced, although gaps in employment had not been explored. Systems were in place to provide new staff with induction and shadowing experience. Essential staff training in areas such as moving and handling was kept up to date, however, staff raised concerns about the lack of specialist training in areas such as continence care. We saw a range of specialist training was available from the provider, however, the regional manager confirmed none of the staff at the service had been provided with this training.
People’s nutritional needs were met and they had were supported and enabled to access healthcare support as and when needed.The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005.
People and relatives gave mixed feedback about staff. They spoke positively about their regular care staff who they said knew them well and were kind and caring. However concerns were raised about the attitude and manner of other staff, including the office staff. People told us they were not always treated with respect or listened to and their choices were not always respected.
People’s care records were not always accurate or up-to-date and did not reflect people’s needs or preferences. Complaints were not investigated in accordance with the provider’s own complaints procedure.
We found there was a lack of consistent and effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved. Following the inspection the provider took immediate action and provided additional resources and senior management support to the service to make improvements. They also agreed voluntarily not to take on any new care packages until further notice.
We found shortfalls in the care and service provided to people. We identified seven breaches in regulations – staffing, safe care and treatment, safeguarding, dignity and respect, person-centred care, complaints and good governance. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response 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.