Background to this inspection
Updated
12 July 2023
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 Health and Social Care Act 2008.
Inspection team
Two inspectors carried out the inspection.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 10 days’ notice of the inspection. This was because it is a small service and we needed to be sure that the registered manager, who was the provider, would be in the office to support the inspection.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We reviewed the last inspection report for the provider and their improvement plan. We used this information to plan our inspection.
During the inspection
We spoke to 5 relatives of people who use the service, the registered manager and 2 members of staff. We reviewed paperwork and systems used to support people including care plans, medicine management and audits. We reviewed recruitment files for 2 members of staff.
Updated
12 July 2023
About the service
Primary Health Team Ltd Southwest is a domiciliary care agency providing personal care to people who live in their own homes. They also provide live-in support to people. At the time of the inspection there were 6 people using the service.
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
At our last inspection in September 2022 we warned the provider the service must improve in several areas. At this inspection we found the required improvement needed had not been carried out. The registered manager was still working directly with people giving them little time to complete management tasks. Recruitment was still not completed in a safe way and systems introduced to keep people safe were not effective.
The registered manager had introduced some auditing systems but the audits we reviewed did not always identify issues; when they did, the registered manager did not always act upon what was found.
A new electronic recording system had been introduced to ensure all information on people was accessible and comprehensive. At the time of the inspection not all information had been moved to the new system. The information that had been transferred at times lacked detail.
The registered manager had introduced a training matrix to ensure they knew what staff had received training, but this reflected that not all mandatory training had been completed by staff.
People and their relatives told us that they were happy with the support they received and they felt the level of care was good.
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 7 December 2022) and there were breaches in regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
We also informed the provider they needed to improve the governance systems to run the service. They had not improved them.
Why we inspected
We carried out an announced comprehensive inspection of this service on 29 September 2022. Breaches of legal requirements were found. We served a Warning Notice around good governance. For concerns around safe care and treatment, safeguarding, staffing including training and recruitment we asked the provider to send us action plan. The provider completed the action plan to show what they would do and by when.
We undertook a targeted inspection to check they had complied with the Warning Notice and to confirm they now met legal requirements. However, they had not. So, we expanded the inspection to look at the whole of safe and well-led as part of a focused inspection. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Primary Health Team Ltd Southwest on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to providing safe care to people, ensuring there was adequate management oversight and employing people in a safe way at this inspection.
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 6 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.
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.