27 January 2015 and 17 February 2015
During a routine inspection
This inspection took place between 27 January and 19 February 2015. The initial visit was unannounced.
The service provides care to people who live in their own home. At the time of our inspection there were 152 people with a variety of care needs who used the service.
There was a manager in place but they were not registered with the Care Quality Commission.
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 2008 and
associated Regulations about how the service is run.
The provider had a safeguarding adults policy for staff that gave guidance on the identification and reporting of suspected abuse. Care workers were aware of how to report suspected abuse or concerns for people’s welfare externally.
Risks were not always assessed prior to the service providing care. This included risks to the individual receiving care and environmental risks. Where risks had been assessed these were not reviewed regularly to ensure they were up to date and reflected the current situation.
There were insufficient care workers to support people safely. The service had regularly missed calls to provide care to people due to insufficient numbers of care workers. The manager told us that the service was recruiting care workers and using agency staff. However, we saw that this had not met the service’s staffing needs and the service had not ensured that people’s needs were met.
People’s safety had been compromised in the management of their medicines. Care workers were observed to administer medicines and this was not recorded. Medicine administration records were not audited to check if people had received their medicines. The service was using two medicines policies and this was causing care workers to be confused as to their responsibilities.
People and their relatives gave some positive feedback about the care workers that provided care, however care workers had not received refresher training to ensure they could meet the needs of people who used the service. Where care workers had been subject to an investigation into their care practice and behaviour this had not been recorded effectively and as a result we could not see that the appropriate actions had been taken.
Three people did not have care plans in place and this had resulted in them not receiving the care and support they required. For example not being supported with having sufficient to eat and drink and with access to other healthcare professionals.
People and their relatives told us they were not involved in the planning of their care and support. They did not feel that the service listened to their views. They told us that when they did contact the service their calls were not always returned. They also told us that they did not feel that if they raised concerns these would be responded to.
The service had some systems in place to monitor the quality of service. However, we saw that these were not always effective. We also saw that where audits had identified deficiencies these were not always addressed.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in multiple regulations. You can see what action we told the provider to take at the back of the full version of this report.