All inspections: 1st Hand Care Ltd - West Midlands

The inspection was unannounced and took place on 13 October 2015 in response to concerns that had been raised regarding the quality of care being provided to people by 1st Hand Care. At our last inspection in July 2014 we found breaches in the regulations relating to the care and welfare of people who use the service and assessing and monitoring the quality of service provided to people.

1st Hand Care is registered to provide personal care to people living in their own homes. At the time of our inspection the service was providing personal care to ten people.

There was a registered manager in post at the time of this inspection. 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.

There were not always enough staff to provide care because calls were not always at the times they were needed and calls were often cut short. The provider had not followed safe recruitment processes and employed staff without completing all the checks necessary to ensure they were suitable to provide care and support to people.

Care staff knew about how to protect people from abuse but the provider did not have an effective system in place and there was a risk that safeguarding concerns would not be raised with the local authority.

We could not be assured that people received their medicines as required because some people said they showed staff how to do their medicines. Staff had not received training in medicine administration nor had their competencies been tested by the provider.

People were not always supported by staff that had the knowledge or training they needed to be able to provide good care to people.

People we spoke with told us staff asked for their consent before providing care. People told us regular staff were caring but this was being undermined because staff were rushed. People said that because of the lack of continuity of staff; staff were less aware of their individual needs. People told us that they were treated with dignity and respect particularly when providing personal care.

People were not clear how to raise a concern or complaint with the provider. The provider did not have an adequate process in place to monitor record and investigate complaints.

We found that there were no processes in place to identify and monitor trends. The provider was not able to evidence that they had any quality assurance processes in place.

During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what regulatory action to take to address breaches in regulation. Once completed we will publish our actions.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Overall summary 1st Hand Care West Midlands provides domiciliary care support to approximately 25 people who live in their own homes. People are supported with their personal care needs to help them to be as independent as possible and support people to be able to remain within their own homes. There was a registered manager in place at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People were supported in a safe way because detailed management plans were in place and staff understood the individual risks to people and how to support people safely.

Staff provided care in a kind and caring way and people told us that staff maintained and protected their dignity when they provided support.

Improvements were needed in the way that the service monitored and assessed the quality of the service provided. Systems were in place but these had not been undertaken regularly.

We found that the service did not always promote an open and inclusive culture for staff to feel empowered in providing their views about the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this inspection in response to a number of concerns that we had received about how the agency was being run. The allegations raised centred around staff not being paid in a timely manner and the provider being unprofessional in their dealings with staff. It was alleged that this had led to a number of staff leaving. As a result it was alleged that there was an impact on the care delivered to people who received the service due a lack of consistency in the way care was provided.

A local authority commissioner informed us that the agency had given them notice to remove packages of care they were providing due to financial difficulties.

We checked to see that people's health and well-being was being promoted by the agency.

Below is a summary of what we found. We visited the agency's office and looked at care records for three people that used the service and other records related to the running of the agency. We spoke with the provider and two staff at the office. Following this visit we spoke with one person using the service, four relatives and five care workers by telephone.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe with the care workers that visited them. On person told us, 'I'm safe' and a relative told us, 'If I didn't feel safe with them I wouldn't have them'. Care workers we spoke with understood their role in safeguarding the people they supported. Some relatives we spoke with told us that the times of the calls they received were not always punctual and as planned, sometimes being up to an hour late. One relative said call times, 'Are well off the mark'. This meant that some people were potentially being put at risk.

People told us that they felt their rights and dignity were respected by the care workers that visited them. One relative told us, 'Staff do explain what they are doing as a rule' and another that, 'They always announce that they are coming in'. Another said, 'They respect if you say anything to them'.

Some people's care plans and risk assessments were not complete or up to date which meant there was a risk care workers may not have access to information about people's current needs. This had the potential for putting people at unnecessary risk of harm.

Records showed that the provider had not taken people's care needs into account when making decisions about the planning for the calls that care workers carried out. Relatives we spoke with reported late calls and some care workers told us that their time sheets showed that they had calls planned for more than one person at the same time.

There was no system in place to make sure that the provider and care workers learned from events such as changes to people's needs, complaints or concerns. This means that people were not benefiting from a service that was taking on board lessons learnt.

Recruitment practice was safe and thorough. We found that care workers were checked to see if they were safe to work with vulnerable people.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to assessment and quality assurance.

Is the service effective?

People's health and care needs had been assessed, although the assessments we saw were not always up to date and the agency had not always put care plans in place. There was limited evidence of people being involved in assessments of their needs and planning their care. Some people or relatives told us that management had not spoken with them about people's changing care needs. Specialist health care needs were not always assessed and included in care plans, for example how to monitor the risk to people with fragile skin. The care plans that were in place had not been reviewed regularly. It was therefore not possible to confirm that all people's needs were being met.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to assessing people's needs and planning their care with their involvement.

Is the service caring?

We asked people and relatives about the care workers that supported people's needs. Relatives told us that care workers, 'Have the skills they need', 'Do trust the ones that come', 'Staff do their job very carefully' and, 'The care they give, they are used to doing a good job'. The care workers we spoke with were well informed as to people's needs and were able to tell us how they would provide care in a way that promoted people's well being and was caring.

Is the service responsive?

We were not assured people using the service, their relatives, friends and other professionals involved with the service had completed an annual satisfaction survey. We heard from relatives that they were not always asked for their views by the agency, although care workers listened to what they said. There were some shortfalls, and concerns that relatives said they had raised but had not been addressed. People were therefore at risk of not receiving good quality care.

People and relatives were not always aware of the provider having a complaints procedures and one person told us if there were issues they would discuss these with the social worker rather than the agency as they knew they would be addressed then. Some people told us they had complained about aspects of their care and they were not satisfied with the outcome of the complaint.

We have asked the provider to tell us how they will make improvements in relation to learning from information they receive from people.

Is the service well-led?

Care workers we spoke with knew how to escalate their concerns to the provider. For example when they felt people needed reassessing by social services due to the length of time allocated to a call, they knew they needed to raise this with their manager. All of the staff we spoke with understood what poor practice looked like and how they would report their concerns.

The service did not have an effective quality assurance system, with records seen by us showing that checks on the quality of the service were dated. We were told of auditing processes that the provider had in place but these were not made available to us when requested from the provider. We were not able to see if there were plans in place to address the shortfalls we identified.

We heard a mixed response in respect of people's views as to their confidence in the provider. Some people told us that they were confident in the care workers but had little confidence in the provider.

Our inspection of 8 July 2013 found that poor recording and monitoring of the way medicines were managed might have resulted in people not being fully protected against the risks associated with medicines and unsafe or inappropriate care. This inspection was carried out to check what improvements the provider had made.

We visited the agency's office on the 2 December 2013. We looked at six people's care records and spoke with two senior staff, two care workers, the manager and provider. We spoke with two people that used the agency, three relatives of people that used the agency and a health and social care professional.

One person we spoke with told us when we asked about the service they received, "Of course I'm happy everything is all right". A relative we spoke with said, "I'm happy with the service at present".

We found that the regular monitoring of the administration records and care worker's competence in administration of medicines ensured that people were protected against the risk associated with poor administration of medicines.

We found that the provider had made improvements to ensure people's records were more up to date, and that their personal information was better protected.

We visited the agency's office on 8th July 2013. We spoke with the provider and five staff and looked at five people's records and other records related to the running of the agency. We spoke with three people that used the agency and four relatives of people that used the service by telephone after our visit.

We heard that care workers provided care and support in a way that respected people's privacy, dignity and independence. One person told us, 'They're alright, they care for me, staff very good'.

We heard people were usually happy with the care and support they received from the agency and that care workers usually visited at the time they needed them. We heard that people were usually able to change the care and support they received and the times they received it. One person said, 'Ask and they change, not missed a call'.

We found that improvements had not been made to ensure there was a robust system in place to monitor the medicine administration records and ensure that the care workers were administering medicines as prescribed to people using the service.

People told us that the provider did check on how care workers supported them and they were able to contact the service if they wished to discuss the service they received.

We found that people's records were not always accurate. This meant there was a risk that they may receive unsafe or inappropriate care and support.

We inspected the agency on 16 October 2012 to check on improvements the provider had made following our last inspection in June 2012. We looked at care records for five people that used the agency, and other records related to the operation of the service. We spoke with one person that used the agency, two relatives, three care workers, the operations manager and the acting manager for the agency.

We found that the quality of people's care records had improved although there were still some inaccuracies in these. People and relatives told us that the care and call times provided were as they wanted and no calls were missed. Care workers knew what people's support needs were and when to visit people. One person said that 'Carers are lovely, do it really well' and that 'Staff very capable" and 'are quite nice and friendly, do help'. One relative told us that the care was okay. They added that 'really good if (their relative) goes in to hospital' as they could make changes to calls. Another relative told us that' Happy with the service' and 'gets on with carers'.

We found that the management of medicines by the service needed to improve further in order to ensure that people using the service received their medicines safely.

We saw that the provider had improved their systems for the monitoring of service so that people could be confident that they were being provided a quality service.

We visited 1st Hand care on the 13 and 22 June 2012 to check on improvements the provider had made after we raised concerns following our inspection in March 2012. We looked at all the information that we had received since our last inspection prior to this visit.

We looked at care records for four people that used the agency, and other records related to the operation of the service. We spoke with two people that used the agency and four relatives. We also spoke to three care workers, the manager and operations manager.

Our findings showed that the there had been some improvements in the quality of care plans. Information about people's health care needs was still not being reflected. In addition, the care plans at the agency's office did not reflect what people and relatives told us was in care plans held in the home. One relative also told us that 'Care plan does need sorting out' as it did not reflect the care received and tasks staff needed to do. Another person said that staff 'know my care plan, know what needs doing'.

The majority of people told us that the standard of care was good or had improved recently. Comments we heard included 'Most carers are very good', 'Happy with the service' and that newer staff 'Absolutely brilliant '.

People told us that they knew who to contact if concerned, telling us contact with social services or the agency had brought about desired improvements. Staff were also aware of the need to raise concerns if they were worried about people's safety.

We had concerns with how the agency managed people's medication. Care workers we spoke with gave conflicting information about the level of support given to the same people for medicines administration. Staff training was also inconsistent and there was no medication competency assessment of staff.

Whilst there was evidence that the monitoring of the agency was improving, there were areas where these systems did not always fully protect people against risks of unsafe care and treatment. Risks were not always identified, assessed and managed and people were not confident that improvements would be maintained.

We carried out this review of compliance in response to concerns that we received from Walsall social services and other stakeholders.

We visited 1st Hand Care on 13 March 2012. During our visit we spoke with the manager and provider. We looked at care records for four people that used the agency, and other records related to the operation of the service. We also spoke with three relatives of people that used the agency and three staff.

We heard that a number of people who used the agency had not received calls as agreed within their care packages. Social services staff had investigated some of these complaints and found that the agency had put people at risk.

One representative told us after they complained there had been an improvement since January 2012. Another person's representative told us since their regular carer changed they 'could set their watch' by the time of the calls. One representative stated that they had little confidence in the timing of the calls as agreed with the agency. They said they had phoned their relative at the time staff calls were to take place and staff had not been there. They also told us that they had difficultly knowing whether the calls were for the length of time that they should be, as requests for written confirmation of this from the provider had not been met.

We looked at care plans for four people that used the agency when we visited. Based on what people's representatives and staff told us we found that there were inaccuracies in the information within these as to the times of calls which should have been made to people. This told us that care plans were not updated and the support people needed was not clear.

We looked at the risk assessments in people's care records. We found that where these had been completed they were contradictory. In two care records we saw little information of how people's health should be monitored where there was increased risk. We also found risk assessments that were blank, even though one was signed by a person that used the agency.

We heard from Walsall social services that they have received concerns from a number of people that used the agency and these cases led to safeguarding investigations being commenced. The main concerns raised centred on missed calls to people meaning that they did not get the support and care that they needed.

There had also been allegations to the lateness of some calls, medication errors and inappropriate behaviour of staff.

One person's representative told us they contacted the agency with concerns but nothing changed until they contacted social services, after which there was an improvement. They told us any further issues would be raised with social services rather than the agency due to a lack of confidence in the agency.

Another person's representative spoke of contacting the agency after a missed call which was addressed with no further problems.

The most recent allegation was reported to social services by the acting manager and was under investigation. Social services have made us aware of other incidents relating to medication errors.

Concerns were raised with us from different sources about medication errors by staff that worked for the agency. We found a lack of robust systems to protect people with their medication. We were told that the agency only 'prompted' people to take their medication. We heard from people's representatives that the staff had administered medication. Confirmation that medication was administered was not always recorded, with only some staff having signed to say medication had been administered. This meant it was unclear as to whether people had received their medication.

We saw in some care records that there was some monitoring of people's satisfaction with the service. The records we saw indicated that people that the management had spoken with on a periodic basis were happy with the service they received. The representatives of the people that we spoke with were unaware of this quality monitoring tool. A number of people and their representatives have expressed to us and Walsall social services that overall they have not been satisfied with the quality of the service they have received from the agency.

Archived: 1st Hand Care Ltd - West Midlands

All Inspections

13 October 2015

During a routine inspection

09/04/2014

During a routine inspection

14 July 2014

During an inspection in response to concerns

2 December 2013

During an inspection looking at part of the service

8 July 2013

During a routine inspection

16 October 2012

During an inspection looking at part of the service

22 June 2012

During an inspection looking at part of the service

14 March 2012

During an inspection in response to concerns