Background to this inspection
Updated
12 September 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was completed by two inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was not present during the inspection as they do not live in the area.
Notice of inspection
This inspection was unannounced. Inspection activity started on 25th February 2020 and ended on 26th February 2020. We visited the office location on both days.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.
During the inspection
We spoke with two people who used the service and four relatives about their experience of the care provided. We spoke with four members of staff including the office manager, office administrator and care workers.
We reviewed a range of records. This included eight people’s care records and multiple medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures and governance documents were reviewed.
Updated
12 September 2020
About the service
Home from Home Care Services Limited - 168 Burton Road Derby is a domiciliary care agency providing personal care. At the time of our inspection, 28 people were being supported by the agency.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
People were not protected from the risk of harm due to inadequate safeguarding procedures and poor assessment and monitoring of risk. People were at risk of infection from poor infection control practice. People did not receive their medicines as prescribed. Staffing levels were inadequate to meet people’s needs and staff were not always recruited safely. There was a failure to learn lessons following incidents and investigations.
People’s care was not planned and reviewed in line with national guidance. Staff training was not effective and left people at risk of harm. People were not always supported appropriately with their nutrition and hydration. Staff did not work collaboratively with healthcare professionals to promote people’s health and wellbeing.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People’s dignity was not respected, and they were not always treated with kindness and respect.
People’s independence not always supported, and they were not consistently involved in their care.
People were not supported to make complaints, and these were not always recorded and reviewed. Care was not planned in a person-centred way and people's interests, relationships, choice and control were not promoted. People’s communication and end of life care needs were not understood or respected.
There was a lack of management and oversight by the registered manager and provider. The registered manager was not part of the day to day running of the service. There was a negative blame culture which did not have people at the heart of the service and there was a lack of transparency within the service. Engagement with people, the public and staff was minimal. There was poor cooperation with external stakeholders and healthcare professionals.
Following our inspection, due to the level of risk, the local authority made arrangements for people to received support from alternative care providers.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 28 March 2019) and there were two multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified 11 breaches of regulations at this inspection. These relate to safeguarding people from abuse, safe care and treatment, safe employment of staff, staffing levels and training, governance and oversight of the service, action with complaints and a failure to provide person-centred care and respecting people’s dignity
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.
Follow up
We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.