All inspections: Nelson - Care Quality Commission

We undertook an unannounced focused inspection of the Nelson branch on 3 March 2016. This was as a result of the Commission receiving additional information and further concerns that related to the care and welfare of people using the service. The concerns related to missed visits, administration of medication and delivery of the care provided. As a result we undertook a focused inspection to look at those concerns. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for the location known as ‘Nelson’ on our website at www.cqc.org.uk

Nelson provides care and support for people in the Burnley and Pendle area. The range of services provided includes, personal care, domestic help and shopping. The service provides support for older people, people living with a dementia, adults with physical disabilities as well as learning disabilities. The agency's office is located in the centre of Nelson. The agency was known to people using the service as Heritage Homecare.

The Nelson branch was last inspected 24, 25, 30 November and 9 December 2015. This was as a result of the Commission receiving concerning information relating to the care received by people who used the service, staff leaving and visits being missed. As a result of this inspection a number of breaches of the Health and Social Care Act (Regulations Activities) Regulations 2014 were identified. The service was rated as inadequate and was placed into ‘special measures’.

During this inspection we identified ongoing breaches relating to safe care and treatment of people using the service. We are taking action against the provider and will report on this when it is complete.

As part of this inspection we visited the Nelson office as well as the head office in Lancaster where the call monitoring systems and the directors are based.

We saw evidence of missed visits taking place, the provider was in the process of transferring care packages to alternative care providers with oversight by the Local Authority. The Director of the Company could give us no assurance that people would receive the care visits that they required.

We received confirmation from the provider that staff at the Nelson branch had not been paid at the end of February. This has resulted in staff leaving and the Company’s continuing ability to meet the allocated visits for people using the service at the Nelson branch.

We were told by a Director that there had been a director who had been to the office on a number of occasions. However all staff spoken with told us the directors of the company had not visited the Nelson branch for approximately three weeks.

We undertook a focused inspection of the Nelson branch 24, 25, 30 November and 9 December 2015. The inspection visit on 24 November and 9 December 2015 was unannounced. This was as a result of the Commission receiving information and further concerns that related to the care and welfare of people using the service. The concerns related to missed and late visits, administration of medication, and delivery of the care provided. The inspection on the 9 December was undertaken with representatives from the Local Authority Safeguarding team along with representatives of the police.

Nelson provides care and support for people in the Burnley and Pendle area. The range of services provided includes, personal care, domestic help and shopping. The service provides support for older people, people living with a dementia, adults with physical disabilities and learning disabilities. The agency's office is located in the centre of Nelson. At the time of the first day of the inspection the service was providing support to seventy six people.

The Nelson branch was last inspected on 16, 17 and 21 September and 14 and 15 October 2015. This was as a result of the Commission receiving concerning information relating to the care received by people who used the service. As a result of the inspection a number of breaches of the Health and Social Care Act (RA) regulations 2014 were identified for Regulations 9 person centered care, Regulation 12 Safe care and Treatment, Regulation 14 Meeting nutritional and hydration needs, Regulation 16 Receiving and acting on complaints, Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper persons employed. The overall rating for this inspection was inadequate and the service was placed 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.

During this inspection we identified ongoing breaches relating to Regulation 12 of the HSCA (RA) regulation 2014 Safe Care and Treatment and Regulation 17 Good Governance. We also found a breach of Regulation 18 HSCA 2008 (Registration) Regulations 2009 Notification of other incidents. As there are ongoing breaches we will report on our actions once our investigation has been completed.

We had been made aware of a number of safeguarding concerns raised about the service that had not been reported to the Commission by the service. As a result of our findings during this inspection we referred our concerns about the deficiencies in care for three people to the Local Authority Safeguarding team.

We looked at ten care files and noted deficiencies in their content. Records were brief and lacked detail to guide staff about people’s individual needs. There was no evidence of specific risk assessment to manage people’s individual need for example falls or medications. Evidence of missed visits was seen along with concerns around inappropriate responses to changes in people’s health conditions.

We asked about how the service monitored that the visits were taking place. We were told that staff called into a call logging system that recorded when the visit had occurred. However we received conflicting information about this system. One person told us there were twenty five lines for this but another staff member said there were only two lines and up to forty five staff could be trying to log in at the same time. We were provided with records of visits for one person although the information provided by the service was different information to that provided to the Local Authority covering the same time frame. This meant that records of visits undertaken were unreliable as it was not possible to determine if visits to people had taken place or not.

We looked at how the service was managing complaints. Whilst there was evidence of a complaints file we could not see what actions had been taken as a result of one response to a complaint that had been filed in it. Team meeting were seen to be taking place but there were no records of who had attended the meetings or actions taken forward as a result of the meetings.

We saw that only three people had been invited to provide feedback about the care they received from staff. Whilst one of the records stated they had, ‘been with the company nine years and were overall happy’, two of these records identified some concerns relating to the care they received. One person’s response to, ‘How would you rate the overall service from the office was recorded as ‘poor’ with the comment, ‘Not very happy at the moment’ they also recorded that they were unhappy with carers attitude.

We identified that audits had been under taken relating to care files since our last inspection however we saw that all of these had taken place on the same day and had been completed by the same staff member. There was no evidence to confirm what actions had been taken to resolve the gaps or requirements in the records identified.

We carried out an inspection of Nelson on 16, 17 & 21 September and 14 & 15 October 2015. The inspection visit on 14 October 2015 was unannounced.

Nelson provides care and support for people in the Burnley and Pendle area. The range of services provided includes, personal care, domestic help and shopping. The service provided support for older people, people with a dementia, adults with physical disabilities and learning disabilities. The agency's office is located in the centre of Nelson. At the time of the first day of the inspection the service was providing support to 135 people.

At the previous inspection on 6 February 2014 we found the service was meeting all the standards assessed.

At the time of the inspection the registered manager had left employment at the service and had applied for de- registration. 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.

During this inspection we found the provider was in breach of eight regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. These were in relation to:

People had experienced missed visits and late visits which resulted in risks to their well-being, comfort and safety. Some risks to individuals had not been properly assessed and planned for, this meant appropriate action had not been taken to identify and reduce the risks to people’s well-being and safety.

People’s medicines were not managed appropriately, which meant there were risks they may not receive safe support.

Staffing arrangements were not properly managed to ensure people received care and support when required, in accordance with their assessed individual needs and preferences. Arrangements for staff training and supervision were not satisfactory in ensuing people employed at the service were competent and had the necessary skills and knowledge to carry out their work effectively.

Staff recruitment practices had not been properly carried out for the protection of people who used the service.

People were not provided with appropriate care and support to ensure their nutritional and hydration needs were met.

Processes for assessing, planning and reviewing people’s care and choices, were not effective in responding to their individual needs and preferences.

People’s concerns and complaints were not properly acknowledged, managed and responded to.

There was a lack of effective systems to consult with people on their experience of the service and to assess, monitor and improve the quality of the service provided. Records were not properly kept to make sure people’s needs are effectively and safely met.

We also found a breach of one regulation of the Care Quality Commission (Registration) Regulations 2009 for non-notification of incidents. You can see what action we have asked the provider to take at the back of the full version of the report.

We found the management and leadership arrangements at the service were not effective in providing people with safe care and support.

People made some positive comments about the staff team including their attitudes and respectful manners. Staff expressed a practical awareness of promoting people’s rights to privacy, dignity and independence. However, we made a recommendation about involving people in decisions about their care.

All the staff we spoke with described the action they would take if someone was not well, or if they needed medical attention.

Staff indicated an awareness of MCA 2005, including their role to uphold people’s rights and monitor their capacity to make their own decisions. There were some policies around this; however we made a recommendation for improvements.

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 our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of 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.

We spoke to four people who received care from the service and found people spoken with were very happy with the care and support they received and spoke positively about the service.

People who used the service were given sufficient information to enable them to make informed decisions about their care and were involved and consulted with.

We found people and their families were involved in their assessment of need and the development of the care plans to meet their need. People's views were taken into account and they were therefore able to influence the delivery of their care. People told us they would contact the carers or the manager if they had any concerns or if changes were needed to their care provided.

Care assessments and care plans were in place and people we spoke with told us about the care plans in place to support their personal care package being delivered. We found people usually had the same team of carers and people experienced safe and appropriate care.

We found safe and effective recruitment processes were in place and the service had a staff team that was appropriately qualified and had completed induction training before providing care to people that used the service.

People told us they felt safe with the service they received and had no concerns about the staff team providing care in their own homes.

We found the service had an appropriate complaints process in place and a log was being maintained. One person we spoke to told us, 'I can't think of one negative thing about the service, they always adjust their service to any changes required and always let me know'.

All the people we spoke with confirmed that the agency provided a very reliable service One person told us, "You can always rely on them. They do a really good job. I am more than satisfied." People told us the care workers who supported them at home were all friendly and always treated them with respect. One person commented, "I like the way they do their job. They are all so pleasant and know what they are doing."

We did not consult people using the service.

We found the agency trained staff in safeguarding vulnerable adults. This supported them to have skills to identify signs of abuse and what they should do about it.

The agency allowed people interested in working for them, visit people before they were recruited. This meant vulnerable people living in the community were identified to people not employed by the agency.

We found when the agency recruited staff, they carried out character checks to make sure the people they employed were of sound character and fit to do the work. The staff were trained properly and supported to care for people using the service.

People using the service said they were getting the support they wanted. They had a care plan and their carers did what was expected of them. Staff were reported to be flexible in their approach and they always turned up. They said 'Every day they pop in to see if I am all right. They will wash up for me and they are reliable. They always ask if there is anything else I want doing before they go'. And, 'Always pleasant and helpful.'

One relative described the staff as being professional and said thought is given to who they send. She said 'On the whole it is a good service and they have achieved good standards'. People using the service told us they usually had the same carers who visited them. 'I usually get the same person matched to the same time on every visit, a bit like a team of carers. I prefer this but I know there are times when this is not possible. Everybody needs time off.' And 'I have my favourites' and I am usually obliged.

People using the service told us they were confident in the way staff presented themselves. They made comments that included, 'I trust them to do what I want and they never take liberties. They always ask permission to go into other rooms when they need to get something'. 'They are all good, no one misses a visit.'

Staff from the agency were described as 'very good', and 'seem to know what to do'. We were also told staff are 'helpful, kind and caring and treat their work as a vocation rather than a job'.

People using the service were confident they could raise any issue of concern to the manager and know it would be dealt with promptly.

Archived: Nelson

All Inspections

3 March 2016

During an inspection looking at part of the service

24, 25, 30 November and 9 December 2015

During an inspection looking at part of the service

16, 17 & 21 September and 14 & 15 October 2015

During a routine inspection

6 February 2014

During a routine inspection

3, 4 December 2012

During a routine inspection

20, 29 December 2011

During an inspection looking at part of the service

31 March and 7 April 2011

During an inspection in response to concerns