Background to this inspection
Updated
10 August 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team: Three inspectors and one expert by experience, who has personal experience of using or caring for someone who uses this type of care service.
Service and service type: Domiciliary care agency
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults who may have a physical or learning disability or a mental health need.
CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
On the day of the inspection 22 people were being provided with personal care by the service.
The service is also registered with the commission to provide care to people housed under supported living arrangements. However, at the time of the inspection, the agency was not supporting anyone under this arrangement so we did not inspect this part of the service.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was also the provider of the service and was supported in the day to day management of the service by another provider.
Notice of inspection: The inspection was unannounced as whistle-blowers had contacted us to raise concerns about records being falsified.
What we did: Before the inspection we reviewed the records held on the service. This included reviewing notifications. Notifications are specific events registered people have to tell us about by law.
The office visit was completed on 25 and 26 February 2019.
At this visit we spoke with:
• a director of the company
• eight staff
We also reviewed
• nine people’s care records
• 12 personnel records
• training records for all staff
• audits and quality assurance reports
• policies and procedures.
• records of accidents, incidents and complaints
• staff rotas
Following the office visit, we made phone calls to
• seven people
• two relatives
• three staff members
• a social worker
We also visited two people and talked with two relatives during the course of these visits.
Following the office visit we continued to request training and recruitment records from the provider so we could be assured people were being supported by staff who were safe to provide care. These were provided.
Updated
10 August 2019
About the service: Annette’s care is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger adults who may have a physical or learning disability or a mental health need.
The service is also registered with the commission to provide care to people housed under supported living arrangements. However, at the time of the inspection, the agency was not supporting anyone under this arrangement.
Rating at last inspection: Requires improvement (6 March 2018)
At the last inspection we found the provider had not always acted to keep people safe. People’s medicines were not always managed safely. The provider had not always assured themselves new staff were suitable to work with vulnerable people. The provider had not ensured systems and processes were in place to monitor the quality of the service and staff practice. Concerns raised or identified had not always been used to improve the service. The provider had failed to notify us of all significant events in line with their legal obligations.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of ‘safe’ and ‘well led’ to at least good. The provider assured us they had already put processes in place to ensure improvements were made.
Why we inspected: Concerns about the service had been raised with us by whistle-blowers, people and relatives, so we decided to inspect the service earlier than required. The concerns included staff providing care to people before checks had been completed to ensure they were safe to work with vulnerable adults; staff providing care who had not received appropriate training; people not receiving their calls at the correct time or for the correct amount of time, or calls being missed without notice; records being falsified; people who need the support of two staff members to move safely, receiving support from only one member of staff; and staff not ensuring people’s medicines and health needs were met.
People’s experience of using this service:
• People did not receive a service they could be assured was safe.
• People received care from staff who had not all been trained appropriately.
• People’s needs were not assessed promptly when they started to use the service. People did not all have records in place that described how they wanted and needed to receive their care.
• The providers were not always open and honest. They had assured us all staff providing care had been recruited safely and trained appropriately. This was not always the case.
• The providers were not up to date with best practice and were not aware of all regulations and legal requirements.
• The providers had not checked the quality of the service effectively.
• New people continued to be accepted to the service even though the providers were having to cover care visits and some people did not have care plans in place.
• Staff did not always feel supported in the role.
• Staff cared for people. People felt staff kept them safe and were responsive to their needs.
More information is in the full report.
We asked the provider to ensure that no staff who had not been recruited safely were enabled to support people. We also reported our concerns to the local safeguarding authority.
Enforcement: We found breaches of regulation. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.
Follow up: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk