Archived: RmB Healthcare

Updated 15 May 2018

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. As part of this inspection we checked that the provider had followed their action plan, provided by them on 22 August 2017 in response to our last inspection.

This inspection took place on 28 February 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the office at the time of the inspection. The inspection was completed by two inspectors over the course of one day, with additional evidence provided following the inspection by the provider, for us to review.

As part of the inspection process the local authority were contacted to obtain feedback from them in relation to the service. We referred to previous inspection reports and notifications. Notifications are sent to the Care Quality Commission by the provider to advise us of any significant events related to the service, which they are required to tell us about by law. As part of the inspection process we also look at the Provider Information Return (PIR). This is a form that asks the provider to give key information about the service, what the service does well and improvements they plan to make, in relation to the five domains we inspect. A PIR was not requested. However as the location was rated inadequate at the last inspection the provider had submitted an action plan to illustrate any improvements they aimed to make. We used this to help plan our inspection.

During the inspection we were unable to speak to any staff. We requested staff contact details from the provider. These were not provided. All information was therefore gathered from the provider during the course of the inspection. We spoke with the local authority regarding the concerns the inspection identified. As part of the working in partnership initiative the local authority completed face to face and telephone reviews of all people currently provided a service by RmB Healthcare. The CQC were provided with the feedback from this to help inform the inspection process further.

Records related to people’s support were seen for all nine people who use the service. In addition, we looked at a sample of records relating to the management of the service. For example staff records, complaints, quality assurance assessments and policies and procedures. Staff recruitment and supervision records for four of the staff team, including the office manager were reviewed.

Updated 15 May 2018

This inspection took place on 28 February 2018, and was announced. RmB Healthcare formerly known as RmB Healthcare (Unit 1035) is a domiciliary care service (DCS). DCS provides support and personal care to people within their homes. This may include specific hours to help promote a person’s independence and well-being. At the time of the inspection nine people using the service were designated support with personal care.

This inspection was carried out to establish if improvements to meet legal requirements planned by the provider after our May 2017 inspection had been completed. The team inspected the service against all five key areas. At the May 2017 inspection the service was not meeting legal requirements and was rated overall as inadequate and placed in special measures. We found the provider was in breach of six regulations. Following that inspection, on 22 August 2017, the provider sent an action plan which identified improvements that needed to be made to ensure the service would no longer be in breach of the regulations.

At the inspection of May 2017, the provider was rated overall inadequate, with two ratings of inadequate in safe and well-led. Responsive, effective and caring were all rated as requiring improvement. At this inspection we found the provider’s rating for the domain of effective had fallen to inadequate. This was a direct result of the provider failing to evidence and ensure care was effectively provided to people. The changes to the key lines of enquiry have meant that additional information is sought in some of the domains.

At this inspection of 28 February 2018 we found there to be a number of continued breaches of the regulations and have judged the service to still be inadequate.

The provider was managing the service at the point of inspection, although had appointed an office manager for day to day administration task oversight. The provider is a person who has registered with the Care Quality Commission to run the service and is a ‘registered person’. 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.

People were not kept safe. Whilst risk assessments were in place for people, these did not provide information to staff on how to minimise the possibility of a risk. This meant that staff did not always know how to manage a risk should one occur. The provider did not have robust systems in place to ensure sufficient suitably qualified or safe staff were employed to work with people. A police check, full details of employment history and photographic identification was missing from staff files.

People received care and support from staff who had not completed the provider’s identified mandatory training, skills and knowledge to care for them. We noted that staff had commenced some training when we had announced our inspection. Competency checks had not been completed by the provider although this was identified within the policies and procedures as compulsory.

There was no evidence that staff were appropriately supervised or supported. Communication within the service had improved, although only three team meetings had taken place since the last inspection. According to the provider's action plan 16 team meetings should have taken place. We did not see any rotas to identify where and when staff were working and with whom. The provider sent shift changes to staff by text message, however there were no systems in place to monitor whether calls had been completed or check to see if these were completed on time.

People told the local authority that staff were caring, and ensured people’s dignity was preserved at all times. People were encouraged to maintain their independence, with staff supporting should this be required. However, care plans although improved since the last inspection, still contained insufficient information to ensure people were supported in a safe manner.

The service was not well-led. The provider did not have adequate systems in place to monitor and maintain an overview of the service. It was unclear how records of people were stored to ensure they remained confidential as there was no secure storage located in the office.

We found a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff were not provided with appropriate training, competency assessment and performance appraisals as was necessary for them to carry out the duties they were employed to perform. The provider had not established an effective system that ensured their compliance with the fundamental standards. We had found the provider had no systems in place to monitor, record or investigate complaints. The provider had not taken the necessary checks prior to employing staff to ensure they were safe to work with vulnerable people. Risks were neither assessed nor mitigated leaving people vulnerable and at risk of harm. The provider did not have the necessary skills, competence to carry out the regulated activity. The fundamental standards are regulations 8 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘special measures’. Services in special measures will be kept under review and, 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. 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. If the service remains in special measures for more than 12 months, the CQC will take appropriate enforcement action. This may include varying the conditions of registration or cancellation of the registration, dependent on what action is deemed appropriate.