We carried out an inspection of 360 Degrees Health Care and Rehabilitation Service Limited on 15 and 16 March and 25 April 2016. This was the first inspection that had been carried out at this service. 360 Degrees Health Care and Rehabilitation Service Limited is a domiciliary care agency. The service provides care and support to people with a variety of needs including older people, younger adults, people with a learning disability or autistic spectrum disorder, people with mental health issues, a physical disability, sensory impairment and people living with dementia. The service is based in Nelson in East Lancashire. At the time of the inspection the service was providing support to 61 people.
At the time of our inspection the service did not have a registered manager in post. 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 was an acting manager in post who told us she had recently submitted an application to the Commission to become the registered manager for the service. We checked our records and found that an application had been received. However, this had been rejected on 17 March 2016 as it contained incomplete information and a further application had not been received.
During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the failure to recruit staff safely, failure to ensure staff had the competence, skills and experience to provide people with safe care and failure to ensure that staff had access to information in people’s homes about their needs and risks. There was also a failure to assess, monitor and improve the quality and safety of the service. We found that staff were recruited without the necessary checks being completed and without references being received from their previous employers. In addition, two staff members were providing care and support to people without having received an induction and appropriate training when they joined the service. Care plans and risk assessments were not available to staff in people’s homes and the service did not have effective processes in place to monitor the quality and safety of care being provided. You can see what action we told the provider to take at the back of the full version of the report.
During our visits on 15 and 16 March 2016, we found that safe recruitment practices were not followed when the service employed new staff. Applicants were not required to provide a full employment history, references were not always sought from an applicant’s most recent or current employer and appropriate checks were not carried out. We discussed this with the manager who assured us that safe practice would be followed in the future.
When we visited the service again on 25 April 2016, following further concerns we had received about unsafe recruitment practices, we found that improvements had not been made. Staff were providing care prior to appropriate checks having been completed.
People who used the service and their relatives told us that care plans and risk assessments were not always available in the home. This meant that staff did not always have access to information about people’s needs and risks and how to manage them.
We found that staff did not always receive an induction and appropriate training when they joined the service, before they provided support to people. This meant that the provider could not be sure they had the competence, skills and experience necessary to provide people with safe care and support.
The people we spoke with told us they felt safe when staff supported them. One person said, “I always feel safe when the staff are helping me. I need help from two carers and two always come”.
The staff we spoke with had a good understanding of how to safeguard vulnerable adults from abuse and what action to take if they suspected abuse was taking place.
People told us they were always supported by the correct number of staff. Most of the people we spoke with told us that staff arrived on time and stayed for the right amount of time. However, one person we spoke with and one relative told us that staff were sometimes late.
We found that people’s medicines were managed safely and people told us they received their medicines when they should.
Most of the people we spoke with were happy with the care and support they received from the service.
Staff understood the principles of the Mental Capacity Act 2005 (MCA) and supported people to make everyday decisions about their care. Where people lacked the capacity to make decisions about their care, relatives told us they had been consulted.
We found that people were supported appropriately with eating and drinking and their healthcare needs were met.
People told us the staff who supported them were caring. One person said, “The carers who come are good. They’re very caring”.
People told us staff respected their privacy and dignity and encouraged them to be independent.
People were involved in planning their care. Where people lacked the capacity to make decisions about their care, relatives told us they were involved.
We saw evidence that the service sought feedback from people about the service they received.
Most of the people we spoke with were happy with the way the service was being managed. One person told us, “The service is managed well. I was contacted by the manager after my second visit to check everything was ok”. However, one person told us they felt the service was not managed well.
We found that effective audits were not completed to ensure that appropriate levels of care and safety were maintained.
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.