Archived: Simply Together Limited

Updated 16 December 2015

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 by one inspector.

We reviewed all the information we had available about the service including notifications sent to us by the manager. This is information about important events which the provider is required to send us by law. We also looked at other information we hold in relation to this service, in particular information sent to us by people using the service and their families. We used this information to plan what areas we were going to focus on during our inspection. We spoke with members of the local authority who have regular contact with the service regarding peoples care.

This was an announced inspection. The provider was given 48 hours notice because the location provides care to people in their own homes and this was to give sufficient notice to arrange for us to visit people with their permission.

This inspection took place between 5 August and 2 September 2015. We visited two people in their homes and we spoke with a further eight people using the service or with their relatives on the telephone. We interviewed three members of care staff and spoke with two team leaders and the manager.

We looked at the 2 care plans of the people we had visited and compared these with the records held in the office and looked at a further 5 care plans. We looked at records relating to the management of the service including three staff files.

Updated 16 December 2015

This inspection took place between 5 August and 2 September 2015. All visits were announced.

The service provides care to over 50 people who live in their own home.

There was no registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 last registered manager had resigned from their position over a year ago and their replacement had been appointed but had not been registered with the CQC and they had also left the service. The regional development manager was managing the service at the time of our inspection and they informed us they had sought registration with the CQC to be the registered manager.

The provider had a safeguarding adults policy for staff that gave guidance on the identification and reporting of suspected abuse. Some staff we spoke with were aware of how to report suspected abuse. However with some staff we were concerned about their lack of written and spoken English. This view was shared by some people who used the service.

An assessment of people’s needs was carried out prior to the service providing care. This included risks to the individual receiving care and environmental risks. Risks reviews for some people were not up to date and hence did not reflected the current situation. Therefore we found that the provider had not ensured that people had been protected from the risks of unsafe care because people’s needs had not been appropriately assessed and reviewed. Care plans did not contain enough detail to enable staff to meet the individual needs of people. Where risks had been identified care staff did not always deliver care in accordance with the risk assessment management plans to keep people safe or ensure it was reviewed sufficiently and maintained up to date.

There were insufficient staff to support people safely and provide care for most of the visits. However we learnt that some staff worked from 06.00 to past 22.00 hours sometimes for 6 or 7 days per week. Although there were breaks between visits to people to provide care. Some staff told us at times they became very tired.

We found that people’s health care needs were assessed. However, people’s care was not planned or delivered consistently. In one case it was not clear whether the person required one to two staff for each visit. The provider had not ensured people were safe because they had not always provided care and support in accordance with people’s individual care plan and accurately assessed their need. This had been discussed with the local authority on a number of occasions but had not been resolved or clarified to the satisfaction of all concerned. By providing one member of staff instead of two staff, placed people and care staff at risk of physical harm.

When the service staff were running late or in danger of missing calls to provide care to people, the service did not have sufficient staff or robust back-up plans in place to deliver the care to people. The service had recently employed an additional team leader to assist the part-time team leader. At the time of the inspection the service lacked the capacity to respond to difficulties when the first line care staff struggled to complete their arranged duty visits to provide care to people.

We saw that some care plans had been reviewed, while others had not been reviewed, on a regular basis. A member of staff informed us this was being attended to and was the result of increased work resulting from new people using the service. Although the service was struggling to provide care to the existing people, it had continued to take on new care packages.

Care plans were written from a generic base and focussed mostly upon tasks, which did not reflect on the unique needs of each individual. The process for reviewing care plans did not make sure that people’s care was reviewed regularly and changes were not always recorded in peoples care or updated in a timely manner. This meant that the provider could not be assured that care staff had the correct information and guidance about how to care for people based upon their needs.

The manager arranged induction training for new staff. However we were aware that one member of staff experienced in care had provided care to people before they had completed their training with the service.

Staff had received training to provide medication safely and the service had medicine policies and procedures, but we found that staff were not attending at specific times to support people take their medicines.

People and their relatives gave positive feedback about the care staff that provided care. The service provided supervision and spot checks to support the staff, although records showed that this was not always as frequently provided as in line with the policy. Staff we spoke with considered they could raise matters as they happened with the service senior staff to be resolved. However staff and relatives and people using the service raised concerns about the general state and repair of the company vehicles that staff used. The manager told us about the arrangements for the cars to be checked over on a two weekly basis by appointed garages. However we learnt that one vehicle which had broken down was not removed from outside of a person who used the service home for over ten days which they found upsetting.

People and their relatives told us they were involved in the planning of their care and support. They felt that the service listened to their views at the initial assessment stage.

At the time of our inspection the service informed us there were no outstanding complaints, although we found the manager was not recording all complaints in the complaints log. The manager dealt with some complaints as they arose under the service safeguarding procedure. Although this meant that the manager was aware of issues this approach resulted in the complaints log not being an accurate record of complaints

The service had systems in place to monitor the quality of service. However, we saw that these were not always effective. As quality assurance systems had not been operated effectively, this meant the provider had not identified the concerns discovered during our inspection. Failure to assess and monitor the quality of the service meant the provider was unaware of areas that were inadequate and had not taken action to address them.

Although some people were content with the service they received and praised the individual care staff, other people did not feel the service listened to their concerns.

The management staff of the service had failed to keep appointments with the local authority staff to discuss aspects of care and concerns. There was no registered manager in place, the provider had only visited the service once this year and we could see no strategies for improving the service.

People had experienced missed and mistimed calls which led to them not being able to attend medical appointments. A relative informed us this had a big impact upon the person and left their relative feeling lonely

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, it 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 the 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 had 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 specials measures.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.