Archived: New Beginnings Independent

The service did not have a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run. Since the previous inspection, the service had made an application to the CQC to register the operational manager as the registered manager. However, the CQC refused the application as the operational manager did not meet regulations in respect of qualifications, experience and competence. The operational manager had not been able to effectively manage the service. This had resulted in a number of deficiencies and breaches of regulations identified in this inspection. However, a new manager had been appointed and had applied to CQC to become registered. The operational manager still worked for the provider and was still managing the service on a day to day basis at the time of this inspection. We identified numerous problems stemming from the failure of the operational manager to adequately manage the service on a day to day basis and the provider for failing to adequately assure themselves that the service was running safely and that the needs of the person who used the service was being met. Deficiencies we noted included lack of references in the recruitment of care workers, issues with the phone, poor record keeping and inadequate scrutiny of financial arrangements for the person who used the service and the lack of consultation regarding decisions made.

The person who used the service had a learning disability and when asked, did not provide us with feedback regarding the quality of the care provided. We however, received feedback from an advocate and two social care professionals. They stated that they were not satisfied with the care provided and they had concerns regarding the management of the service.

The service had a policy and procedure for the administration of medicines. There were appropriate arrangements for the recording, administration and disposal of medicines. The person concerned had been given their medicines as prescribed. There were no gaps in the Medicines Administration Record chart examined (MAR).

The person’s care needs and potential risks to them were assessed and care workers were aware of risks to this person. A personal emergency and evacuation plan (PEEP) was prepared and care workers knew what action to take in an emergency. The service had guidance for care workers on lone working.

The service had arrangements for safeguarding people. There was a safeguarding adult's policy and care workers were aware of action to take when they suspected abuse had taken place. One safeguarding allegation of neglect had been reported to us prior to this inspection. This was investigated by the local safeguarding team and found to be substantiated overall. The concerns related to the way the person’s money was managed by the service and the lack of adequate social and mental stimulation. The service had responded and taken action to improve the care provided. This had included closer management support, better care documentation and ensuring that the person had sufficient funds available for their care needs.

We found that the service did not follow safe recruitment procedures. We examined four staff records. The record of one care worker contained no references. The record of a second care worker contained only one reference. We have made a requirement in respect of this.

Two care workers worked very long shifts ranging from two to three 24 hour shifts which included sleeping in duty. This places the person concerned at risk of not receiving safe and appropriate care. It also placed the care workers concerned at risk of tiredness and ill health. We have made a requirement in respect of this.

There was evidence that most care workers had received essential training which included health, administration of medicines, ensuring equality and promoting diversity and safety and safeguarding. New care workers had received a period of induction. Supervision and appraisals had been arranged for care workers.

We found that the service did not work in accordance with the principles of the MCA and consent had not been obtained for certain important decisions made for the person being cared for. The service had not consulted with either the person using the service or their representatives when changes were made to this person’s telephone network. No consultation was carried out when one of the activities this person had been involved in was changed and later stopped. We also noted that this person’s money had been used to purchase a microwave and landline phone. There was also no record of consent being given either by the person concerned or their representatives or best interest decisions recorded regarding these. We have made a requirement for this.

Care workers were caring in their approach and able to communicate with the person concerned. They were knowledgeable regarding the needs of this person. The person’s care plan contained information regarding their likes and dislikes, weekly activities, cultural and religious background. Care workers we spoke with had a good understanding of the importance of treating people with respect and dignity. The service had a policy on ensuring equality and valuing diversity. We however, saw no documented evidence of best interest decisions or consultation with this person since the last inspection in March 2017 regarding their preferred activities and items purchased on their behalf. A review of care had been carried out recently by the funding authority. They concluded that the person concerned was not receiving sufficient mental and social stimulation. The service had responded to this and more activities had been arranged.

Three care professionals and the advocate of the person concerned expressed disappointment with the management of the service. We identified several shortcomings in the management of the service. Some checks had been carried out. These were however, not sufficiently comprehensive and had not identified deficiencies noted such as the lack of references in the recruitment of care workers and inadequate scrutiny of financial arrangements for the person concerned. We are considering what action to take in respect of this breach.

The service had a complaints procedure. No complaints were documented. The manager stated that none had been received.

Infection control measures were in place. The premises had been kept clean with the assistance of care workers. The healthcare needs of the person concerned had been monitored and appointments had been made with healthcare professionals when required. There were arrangements for assisting the person with their dietary needs.

The service was not well managed and we identified several shortcomings and breaches of regulations. Although checks of the service had been carried out these were however, not sufficiently comprehensive and consistent and had not identified deficiencies noted such as lack of references in the recruitment of care workers, issues with the phone, poor record keeping and inadequate scrutiny of financial arrangements for the person who used the service and the lack of consultation regarding decisions made. These were brought to our attention following safeguarding investigations into a complaint made. Failings of the service had not been promptly identified and rectified by the manager and senior management of the service.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.

At our previous inspection on 16 January 2015 we rated the service as “Good” and there were no breaches of regulations. At this inspection we found the service remained “Good”.

The registered manager left the organisation in August 2016. There was a new manager in post at the time of the inspection. She provided us with evidence to confirm that she was awaiting the results of her criminal check before making an application to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run. The manager also managed three small care homes in North West London.

The care workers we spoke with showed an understanding of how to recognise and report allegations of abuse. Risks to people who used the service were assessed and appropriate risk management plans were in place. Care workers were carefully recruited and the staffing levels were adequate. Medicines were managed safely and infection control arrangements were in place.

One of the three care workers had not been provided with training in food hygiene and manual handing. There were regular staff supervisions. However, appraisals had not been carried out in the past twelve months. The manager stated that all appraisals would be completed by April 2017 and all the required training for one care worker would be arranged..

Healthcare and Mental Capacity Act 2005 (MCA) issues had been addressed.

Care workers were aware of the importance of treating people with respect and ensuring their dignity and privacy was maintained. There were arrangements for ensuring that the care provided was centred around the person who used the service. A recent review by a social care professional indicated that the care needs of this person had been attended to. The service had a complaints procedure. The service did not receive any complaints since our last inspection.

Care workers worked well together. Appropriate policies and procedures were in place. Care records were up to date. However, quality assurance checks were not sufficiently comprehensive and no written audits were seen by us. These are needed to ensure that people receive a high quality of care. Communication and changes had not been fully communicated to a professional involved with the person concerned. the manager indicated that improvements would be made to ensure that this professional is informed.

We have made a recommendation that comprehensive checks and audits be carried out to ensure deficiencies are promptly identified and rectified.

Further information is in the detailed findings below.

We were not able to speak to the person using the service because they had complex needs. We gathered evidence of the person's experiences of the service by observing how they were cared for, looking at their care records, speaking with staff and their advocate.

People who used the services received appropriate care and support that met their individual needs and were treated with dignity and respect.

There were processes in place to protect people using services from harm. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

Members of staff were supported to provide care and treatment to people who used the service and were being trained, supervised and appraised appropriately.

Records kept were fit for purpose and held securely.

We found improvements had been made following our previous visit on the 3 August 2012. People did have appropriate care plans in place that gave staff sufficient information to ensure the safety and well-being of people using the service.

We looked at how the service was protecting people from the risk of abuse. There was suitable arrangements in place. Staff had received additional training and were able to tell us how they would identify and report abuse. We also found their was an appropriate system in place to manage the daily finances of people where the service was responsible.

Records in the service relating to staffing showed that improvements had been made. People were now supported by a consistent staff team that were appropriately trained. Staff also received regular supervision and professional development. We also found there was a robust recruitment and selection process in place which means that people were not at risk or receiving care from unsuitable staff.