Archived: Doves Care Services

The service was previously inspected in September 2015 when it was rated ‘good’ overall, with the key question of well-led rated as ‘requires improvement’. We identified a breach of Regulation 17 (good governance) of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection the provider sent us a plan detailing the actions they were taking to improve. At the time of the inspection in September 2015 the service was supporting five people.

You can read the reports from our previous inspections, by selecting the 'all reports' link Doves Care Services Ltd on our website at www.cqc.org.uk.

This announced inspection was undertaken on 12 and 17 May 2017. The inspection was undertaken by one adult social care inspector.

The registered provider also held the role of registered manager. 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 was not managing the service in a way that protected people from the risk of harm from unsafe care. Systems in place had not been effectively implemented to ensure people received safe and responsive care and support. Staff recruitment practices were not safe and staff did not receive training in relation to their role and to support their understanding of people’s care needs. Insufficient staff were recruited to ensure people received support from staff in a timely way and at times staff were working excessive hours to provide care. Care plans and risk assessments were insufficiently detailed to provide guidance and information to staff about people’s care needs and how to mitigate risks to their health and safety.

The provider did not have an understating of their legal requirements relating to their registration with the Care Quality Commission. The provider was not aware of the implementation of the Health and Social Care Act 2008 which came into force in April 2015. This meant the provider did not have an understanding of the requirements of this Act and where they were in breach. The provider had given misleading information to CQC during the registration process.

Prior to this inspection, in May 2017 we had received information from the local authority’s safeguarding team that the service’s recruitment practices were unsafe. The provider was in consultation with the safeguarding team as well as the commissioning authorities responsible for arranging people’s care as they were seeking assurances the service could provide safe care and support to people.

Following the inspection we received confirmation from the local authority that they had ceased contracting with Doves Care Services Ltd. All those people supported by the service had been provided with alternative care services. The provider gave us assurances they would not provide a service to any new service users until they had made improvements. They told us they would confirm this in writing however they failed to do so.

At the time of this inspection, the provider employed four care staff and two administrative staff. We reviewed the service’s recruitment practices for staff currently employed and for staff previously employed by the service but were no longer working for them. None of these staff had been recruited safely and the necessary pre-employment checks to ensure staff wee suitable to work with people who might be vulnerable had not been undertaken. None of the staff had current disclosure and barring checks (police checks) and references from previous employers had not been sought for six out of the seven staff files reviewed.

The provider was unable to provide us with evidence that staff had received induction training or training in relation the needs of the people they would be supporting. Staff had not received supervision or had their competence to work safely assessed. For example, staff had not received training or had their competence checked in the safe use of a hoist needed to assist one person with transferring from their bed to their chair or for another person, with the administration of eye drops. Staff were not provided with supervision and the provider had not undertaken spot checks to ensure staff were working safety and in line with people’s preferences.

Insufficient staff were employed at the service to ensure people received care in a timely way. The provider told us they undertook care visits when staff were on holiday or sick. However, both the office staff told us they had undertaken care visits due to staff shortages. Neither of these staff had received training or had been introduced to any of the people receiving support. People told us that although they had not had any missed visits, sometime their visits were very late. We looked at the duty rota for one person for the week following the inspection and saw they were working seven days that week. For five of those days they were working from 06:45 to 21:00 providing up to 14 visits, with three breaks between visits. Due to staff shortages, one member of staff told us they had been told by the provider they had to work despite being unwell.

At the previous inspection in September 2017 we identified the provider had not maintained accurate, complete and contemporaneous records in relation to each person receiving a service. At this inspection in May 2017 we found improvements had not been made. Records relating to people’s care needs and any associated risks were poorly recorded and did not provide an accurate or detailed description to ensure staff could provide safe care and support. The findings of risk assessments had not been included in people’s care plans. Staff were not provided with clear information about people’s specific care needs and how they should offer support. In addition, the support people required to maintain their health and the impact of health conditions on people's support needs were not recorded in care plans. This placed people at risk of receiving unsafe care.

Each person receiving support was provided with a Service User Handbook and Guide. This handbook provided people with information about the service’s key policies and procedures. However, other than a reference to having access to a formal complaints procedure, people were not provided with information about how to make a complaint. Those people we spoke with said they felt they could raise concerns with the provider should they have any. Two people told us they had raised concerns and the issues had been resolved and dealt with to their satisfaction. However, the provider had failed to record these concerns in line with their own policies and procedures.

The service had a policy regarding internal quality audits. These included reviewing whether risk assessments and care plans been fully completed. However, the use of these audits had not identified the concerns we raised during this inspection and provided information that was inaccurate. For example, the internal audit identified nutritional reviews had been undertaken every three months or when significant changes occurred. However, we found that no nutritional assessment had been undertaken for one person identified at risk of not eating enough to maintain his health. Shortly before this inspection, the local authority had provided support to the service through its Quality Assurance and Improvement Team (QAIT). A service improvement plan had been developed which detailed the actions required by the provider to address the shortfalls in the management systems. The provider said they were reviewing their systems to ensure they were used more effectively.

People told us the communication from the service was not always good, although this had improved since the appointment of two office staff. Records showed this was a concern raised by people in the service’s quality survey sent to people in August 2016. The provider had failed to act upon people’s feedback to improve their service. However they were now confident that with office staff in place this issue would be resolved. Other comments included in the surveys showed people’s satisfaction with the service. One person said, “Happy with the service” and another said, “The girls do a marvellous job.”

People told us they were happy with the care staff who supported an assisted them. One person said the staff were kind and polite. Another praised the staff saying they were “good at their job”. They said, “They have a sense of humour and we have a laugh.” They told us how much they enjoyed having a conversation with the staff when they visited. The relative we spoke said his relative “likes them [the staff] very much.”

Staff spoke about the people they supported with kindness. One member of staff said, “They’re all really lovely.” Another recognised how importance their visits were to people as many people lived alone and were lonely.

We made four recommendations and identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result we placed a condition on the provider's registration that the registered person must not admit any service user to Doves Care Services without the prior written agreement of the Care Quality Commission. 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.

The overall rating for this service is ‘Inadequate’ and the service i