18, 23, 25, 27 June and 8 July 2014
During a routine inspection
Two adult social care inspectors carried out this inspection. We considered all the evidence we had gathered against the outcomes we inspected in order to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary incorporates what people using the service, their relatives and the staff told us, what we observed and the records we looked at :
-Is the service safe?
We heard a number of examples from people about how the poor organisation, lack of continuity and missed calls had resulted in care not being delivered in line with their care plan and potentially placing them at risk.
Three of the six people we spoke with told us that Ark Home Healthcare 's inability to provide consistent care workers at the time they required caused them anxiety and impacted upon their care needs and sense of safety. One person commented, 'I don't want different people coming in and out of my home. I don't like strangers coming, it makes me panic; I feel safe with carers that know me'.
During our inspection we identified that Ark Home Healthcare had failed to acknowledge some people's preferences for support. One person said they had repeatedly asked for only female care staff. They told us that male care workers continued to be sent for at least one call per week. This person said they, 'went without', should a male care worker arrive to support them with their personal care needs. We found there was an effective process to ensure that employees were of good character and held the necessary checks.
We identified that systems in place to assess and monitor the quality of the service were not effective. For example, we found there was no system in place to identify whether care staff had received training to meet the individual needs of the people they supported. We also identified that workers scheduling support sent care staff who had not received training in the needs of the people they supported. For example, care staff supporting people with diabetes had not received diabetes training. This placed people at risk of unsafe care and treatment.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting people's care and welfare needs, supporting staff and ensuring that there is an effective system to assess and monitor the quality of the service.
- Is the service effective?
People told us they were involved in the writing of their care plans. Care staff told us the care plans provided them with the information they needed to meet people's needs.
Some care staff told us they had informed the provider that a number of care plans needed to be reviewed and updated. They told us these reviews had not taken place. Our review of the provider's own compliance audit confirmed that 28 of 109 care plans had not been reviewed within the past year. It was therefore not possible to confirm that all people's needs were being met.
We heard examples of how Ark Home Healthcare s' failure to provide an effective service had potentially impacted upon the health, safety and welfare needs of five of the six people we spoke with. People raised concerns about their care workers frequently being late, failing to provide their support, being unfamiliar to them and their needs and not staying for the required amount of time.
We identified that a number of staff had not received training and supervision within the provider's identified timescales. For example, 28 of the 64 members of care staff working for Ark Home Healthcare at the time of our inspection had not received moving and positioning training within the providers identified yearly timescale. 52 members of staff had not received supervision within the providers identified timescale. These shortfalls increased the risk of people receiving unsafe care.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting people's care and welfare needs and supporting staff.
- Is the service caring?
Each person we spoke with was positive about the regular staff that visited them. One person stated, 'the regulars are good; they know me exactly'. The relative we spoke with said their family member had a consistent, 'good bunch of carers and is flourishing'.
People were less complimentary about the care and support they received from care staff and care organisers when their regular care workers were not available. One person described the member of staff sent to cover one of their calls as, 'stern and forceful', and said, 'she only spoke two words to me'. Another person described an on-call organiser as 'abusive and not helpful'.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting people's care and welfare needs and staffing.
-Is the service responsive?
Five of the six people spoken with told us Ark Home Healthcare did not inform them if their care workers were running late or were unable to provide their care. People told us that calls made to the provider's head office in Sheffield and on-call system were often not answered or returned. One person said, 'they never get back to you so I've given up calling now'.
Care staff also talked about the difficulty they encountered contacting the provider's head office and calls not being returned about the issues they reported.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in order to ensure that there is an effective system to assess and monitor the quality of the service.
-Is the service well led?
Our conversations with members of the management team and our check of records identified that, whilst there were some systems in place to monitor and identify shortfalls in the quality of the service, these were often disjointed and ineffective in practice.
People told us they had mentioned issues such as their care workers being late or their care preferences not being recognised to the field care organisers and to the staff who undertook regular 'service user telephone monitoring checks'. The provider's audit document recorded that 80% of people supported by Ark Home Healthcare in the Leeds area had received a telephone monitoring call. No analysis of the number of people who were happy or dissatisfied with the quality of the service provided was recorded. Whilst we saw evidence that some of the issues raised within these call had been addressed, a number of issues remained unresolved and therefore continued to reoccur and be documented within subsequent monitoring calls.
The spread sheet used by the provider to document key audits and checks about the quality of the service identified a number of shortfalls. For example, 'spot checks' to assess the support provided by 52 of the 64 workers had not taken place within the provider's specified timescale.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in order to ensure that there is an effective system to assess and monitor the quality of the service.