The Care Quality Commission (CQC) has rated HF Trust Limited – Kent DCA, a domiciliary home care service inadequate and placed it in special measures to protect people using its services following an inspection in May and June.
This unannounced focused inspection which looked at how well-led, safe and effective the service is, was prompted in part due to safeguarding concerns around the care of people who would be vulnerable if left alone outside the supported housing environment.
The service which is provided and run by HF Trust Limited operates across Kent in clusters, each with their own operational manager, overseen by the registered manager. They provide personal care to people at 12 supported living settings and were providing care for 69 people living in their own homes at the time of the inspection.
As well as the overall rating dropping from good to inadequate, the rating for how safe and well-led the service is has also dropped from good to inadequate. The rating for how effective the service is has dropped from good to requires improvement. How caring and responsive the service is, wasn’t looked at during this inspection so they remain rated at good.
The service has now been placed in special measures and the CQC has issued two warning notices to focus HF Trust Limited’s attention on making rapid and widespread improvements to how they are providing safe care and treatment and managing the service.
Rebecca Bauers, CQC’s director for people with a learning disability and autistic people, said:
“Our experience tells us that when a service isn’t well-led, it’s more likely they’re unable to meet people’s needs in other areas we inspect, which is what we found at HF Trust Limited - Kent DCA. Leaders weren’t managing this service well, and standards of care had deteriorated significantly since our previous inspection. A lack of cohesive, effective leadership resulted in people being put at serious risk of avoidable harm and abuse.
“It’s unacceptable that the most basic of people’s needs weren’t being met, which sometimes resulted in them coming to actual harm, particularly around medications. One person having a seizure wasn’t given medication to stop this, another person at risk of constipation ended up in hospital because they weren’t given preventative medication. The provider wasn’t keeping people safe from the risk of harm, we saw another person at risk of falls, who had fallen down the stairs during a fire evacuation because adaptations such as a bespoke chair was not used to support safe evacuation.
“There were not enough skilled and competent staff on duty to keep people safe, this must be addressed as a priority.
“We found there wasn’t a positive culture and people weren’t being supported to live their lives with maximum choice and control. We saw care could sometimes be restrictive, for example one person had an audio monitor in their room, but we saw no evidence that this was the least restrictive option and in their best interests.
“We were also concerned to find that although staff had training on how to recognise and report abuse, not all incidents were documented to raise concerns. For example, staff hadn’t completed an incident form or left any guidance following a choking incident. Recording and reviewing incidents can help spot triggers and patterns to avoid them from being repeated.
“However, feedback we received from relatives at the inspection was generally positive about the care staff provided and the registered manager was receptive to our concerns during the inspection and took some action to address them.
“We’ll continue to monitor the service to ensure all the necessary improvements are made. We’ll return to check they’ve made the required improvements, if we are still not assured people are receiving safe care, we’ll not hesitate to take further action.”
Inspectors found:
- Some communication reviewed about people wasn’t respectful
- Risks to people’s health were not always assessed and well managed across clusters
- Medicines weren’t always being managed safely
- People didn’t always receive timely consistent support
- People and their relatives weren’t always involved in care planning
- Leaders told us the service was moving to an online care planning system, but this wasn’t up and running at the time of our inspection.
However,
- In some areas people were encouraged to cook and eat together as a social gathering
- People were supported to keep their homes clean
- People were supported to have flu and COVID-19 vaccinations.