Archived: Arion Care Ltd

Updated 19 July 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 14 June 2016 It was carried out by one inspector. We gave the provider 48 hours’ notice of our visit so that we could make sure that the relevant people would be available to facilitate the inspection. An expert by experience telephoned people in their own homes to gain their views of the service. An expert-by-experience is a person who has personal experience of using or caring for someone who uses a service, on this occasion a domiciliary care service.

We looked at the information we already had about this provider. The provider was asked to complete a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This information was received when we requested it.

Providers are required to notify the Care Quality Commission about specific events and incidents that occur including serious injuries to people receiving care and any safeguarding matters. We had received some concerns from a number of sources about this service which we passed to the local authority. The local authority commissioner provided us with information about recent monitoring visits to the service. We used this information to plan what areas we were going to focus on during our inspection.

During this inspection we spoke to one of the providers employees who advised that they were managing the service on a day to day basis until a new manager was registered with CQC. The new manager who had been employed was not available during the inspection. We also spoke with the care co-ordinator and two care staff. We also spoke with four people who used the service and with the relatives of six people.

We reviewed some of the care records of three people who used the service and four staff recruitment and training files. We also reviewed records relating to the management and quality assurance of the service.

Updated 19 July 2016

This inspection took place on 14 June 2016. We gave the registered provider notice of the inspection to make sure that the manager and the records we needed to look at were available on the day of the inspection. Arion Care Limited provides personal care to people living in their own homes. At the time of our inspection we were informed that they were providing a service to 37 people.

The service was last inspected in April 2015 when we found the service was not compliant with one of the regulations we looked at. The provider did not have suitable arrangements in place to monitor and improve the quality of the service. We issued a requirement notice and asked the provider to send us an action plan detailing the improvements they would make. An action plan was received. We revisited the service in June 2016 and found the regulation had not been met. In addition we identified other issues of concern related to safety issues.

We found that whilst there were some systems in place to monitor and improve the quality of the service provided, these were not always effective in ensuring the service was consistently well led and compliant with regulations. Audits and monitoring systems needed to be improved; these included the monitoring of recruitment practice.

There was not a registered manager in post at the time of our 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. One of the providers employees advised that they were managing the service on a day to day basis until a new manager was registered with CQC, they advised that they were the deputy manager. Staff and people using the service regarded this person as the manager and referred to them in this way. The new manager who had been employed was not available during the inspection.

Staff and relatives told us that people were safe. However, systems in place did not ensure that people would be protected from the risk of harm. The provider was not always following their own policies to ensure that safe recruitment processes were in place, and the lack of assessment of risk posed a risk to people who used the service.

Although people received their medication safely most of the time improvements were needed in the recording and monitoring of medication administration.

People could not be certain their rights in line with the Mental Capacity Act 2005 would be identified and upheld as issues of capacity and consent were not always fully understood by staff. Improvement was needed to ensure that staff had the training they needed, we saw induction of new staff was not fully completed. There was insufficient assessment of the competency of new staff to provide care effectively. Staff did not receive regular supervisions. We could not confirm that the service performed regular spot checks on all staff, to make sure they were working within safe practices.

People were fully involved in planning their care to ensure they could receive support in the way they wished. Peoples care was reviewed with them and care plans were altered accordingly if changes in care were requested. Most people we spoke with were happy with their care, and said that staff were kind and professional and respected their dignity and privacy. We saw that staff were reporting when they were concerned about people's welfare and that appropriate steps were taken in these cases. Care staff knew how to support people to ensure they received enough food and drink and when it would be necessary to approach other healthcare professionals for additional support.

There was a complaints procedure in place and people told us that they would not hesitate to contact the agency office if they had a concern. Improvement was needed to make sure the service learnt from people’s experience.

The service did not have effective systems to monitor and improve the quality of service people received. The system in place had failed to identify that the regulations had not been complied with. We received positive feedback from people and staff about the deputy manager but we found that arrangements for checking the safety and quality of the service by the registered provider were not effective. The leadership and management of the organisation had not ensured people would receive a service which safely met their needs.

We found breaches of Regulations with regards to staff recruitment, and good governance. You can see some of the action we told the provider to take at the back of the full version of this report. We are considering what further action we are going to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.