Archived: RmB Healthcare

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.

The provider was managing the service at the point of inspection. 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. Risks were not assessed to minimise the possibility of a harm. This meant that staff were not given guidance and may not know how to manage a risk should one occur. The provider did not have systems in place to ensure sufficient suitably qualified staff were employed to work with people. References, gaps in employment history and photographic ID was missing from staff files, including that of the provider.

People received care and support from staff who did not have the necessary skills and knowledge to care for them. The provider did not invest in training. Inductions involved staff reading people’s files and shadowing existing staff.

Staff were not appropriately supervised or supported. Communication within the service was poor, with no team meetings taking place or adequate information sharing occurring, except those related to rota’d shifts. The provider had bought staff mobiles, so that any changes to shift patterns could be passed over.

Whilst documents on how to support people were not in place, in files, people spoke positively of the support they received. We were told 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.

The service was not well-led. The provider did not have adequate systems in place to monitor and maintain an overview of the service. Staff retention was a further issue.

We found a number of breaches in regulations 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. 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 is ‘Inadequate’ and the service is therefore 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.

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.

We spoke with commissioners who had recently carried out a review of the care being provided to the people who use the service. Feedback from them confirmed that they felt the needs of the current people using the service were being met and that people had been complimentary about the care provided and the staff providing that care.

We found there were usually enough qualified, skilled and experienced staff to meet people's needs. However, the provider had not taken appropriate steps to ensure there were sufficient staff available at all times. There was no plan in place to ensure people who use the service would continue to receive personal care in the event of short notice and/or unforeseen staff absence.

The provider had taken some action but did not have suitable arrangements in place to ensure people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had not made sure that people were protected against the risks of unsafe or inappropriate care arising from a lack of proper information about them. The provider had not maintained an accurate record of each person including appropriate information and documents in relation to the care provided. Other records related to the management of the regulated activity could not be located promptly when required.

We found the provider had taken some action towards undertaking suitable management training. However, the actions taken by the provider did not match the actions he told us he had taken in his report of actions. For example: the provider had not had someone suitably qualified carry out an analysis of his training needs to enable him to source and undertake appropriate training. The provider had not enrolled on, or begun, the Level 5 Diploma in Leadership for Health and Social Care. This meant the provider had not taken appropriate steps to reach compliance.

In the report of actions filed following the last inspection the provider stated he had: "made the decision that, until our contingency of two further staff members are processed and trained the business will remain its current size and will not take on any new clients'" At this inspection the provider confirmed that statement still applied and confirmed he would not take any new clients until two additional staff were recruited and fully trained.

Since our last inspection the number of people using the service had reduced from 14 to four. We found the reduction in numbers of people who use the service meant there were sufficient numbers of available staff hours to provide the contracted packages of care. We also found the provider had more time to dedicate to management work related to the managing and carrying on of the regulated activity. However, there was no system in place for determining the training and skills needed by staff to meet the needs of the individual people who use the service. This meant the provider could not ensure staff available were suitably skilled and experienced.

The provider had taken some steps and booked initial induction training for staff, but other suitable arrangements had not been put in place to ensure that staff providing personal care were appropriately supported in relation to their responsibilities.

The provider had taken some steps towards identifying what actions he needed to take in relation to his own training. However, no additional training had been booked or undertaken that related to the skills needed for carrying on or managing the regulated activity.

CQC considered the above failures to comply with the regulations were too serious to wait for the publication of the full inspection report. For that reason we wrote to the provider after the inspection requiring a written report of the actions he planned to take to reach compliance. We required that report to be sent to us by 09 May 2014. We will review the report when received to ensure the actions planned, if followed, will enable the provider to reach compliance in the shortest time possible.

We spoke with one person who uses the service who told us they were satisfied with the service provided and felt their care needs were being met. We spoke with the commissioning team of the local authority who told us people they fund had no complaints about the care they received and were satisfied with the service provided.

However, we found the provider had not ensured that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced staff employed for the purpose of carrying on the service.

The provider did not have suitable arrangements in place to ensure that staff providing personal care were appropriately supported in relation to their responsibilities. Staff had not received appropriate training and supervision to enable them to deliver care and treatment to people safely and to an appropriate standard.

People were not protected from the risks of unsafe or inappropriate care and treatment because records related to their care and treatment were not complete and could not be located promptly when required. We were unable to evidence that such records were stored securely and remained confidential as they were stored away from the registered premises in the provider's own home.

The provider had not undertaken training to ensure he had the necessary experience and skills for managing and/or carrying on the regulated activity.