Archived: Primary Health Team Ltd Southwest

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.

Primary Health Team Ltd Southwest is a domiciliary care agency providing personal care for people living in their homes. They also arranged for staff to live in people’s homes to provide personal care. At the time of our inspection there were six 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

People and their relatives were positive about the level of support and care they received. Their views were staff were kind and caring who respected them as individuals. However, we found there were wide ranging shortfalls with the management of the service. Due to staff levels the registered manager was unable to ensure systems were in place to keep people safe and meet their needs. Recruitment systems were not in place to keep people safe. Neither were systems to manage medicine safely.

Systems and policies that were in place since registration were not being used. The registered manager was not applying guidance, legislation and standards to running the service. This had led to wide ranging shortfalls and inability to identify concerns.

Staff told us had they not received training from other places of work they would lack knowledge to keep people safe and meet their needs. No training systems or competency checks were in place at the time of the inspection.

Records were not reflecting information being shared with us verbally by people, staff and relatives. Care plans lacked guidance to ensure consistent care was received by people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interest. However. the policies and systems in the service did not always support this practice

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 27 January 2022 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding, assessing risks, management of medicines, recruitment of staff, recording or people’s personalised care needs and staff training. We also found systems were not in place or in line with policies to manage the quality and safety at this inspection.

We have also recommended the provider reviews how they record decisions for people who lack or have fluctuating capacity and applying the duty of candour.

We served a warning notice to state the governance systems needed to be improved by a certain date. We will go back and check this has been met.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.