We inspected Elmar Home Care Limited on 16, 22, 23 and 24 August 2016. We usually give the provider 48 hours notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies to make sure the registered manager can be available. However, the registered manager had planned leave on the date we intended to inspect the office, so we rearranged the date which gave the provider five days notice.The last inspection took place on 8 September 2014, when we found one regulatory breach which related to medicines.
Elmar Home Care Limited is a domiciliary care agency which provides care services to people in their own homes. When we visited the office the registered manager told us 88 people were receiving a personal care service. The agency provides a service to adults, older people, people living with dementia, people with physical disabilities, learning disabilities, sensory impairment and people with mental health needs.
There was a registered manager in post, who was also the nominated individual for the Company. 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.
Although people who used the service and relatives praised the kindness and caring attitude of the staff, they expressed concerns about the reliability of the service and the turnover of staff. They told us staff did not arrive at the times which had been agreed with the agency. We found agreed call times were recorded on the computerised system however there was no documented evidence to show when or who had been involved in discussing and agreeing these times. We saw issues around call times had been raised with the provider, sometimes repeatedly, but had not been resolved.
We found medicines were not managed safely as there were no records to show what medicines people were prescribed and administration records were incomplete. This meant we could not be assured people were receiving their medicines appropriately. These concerns had been identified at the previous inspection in September 2014.
The staff recruitment process was not robust as full checks had not been completed to make sure staff were suitable to work in the care service. Staff were not being provided with the necessary support and training to ensure they had the skills and knowledge to meet people’s needs.
Although people told us they felt safe with the staff we found safeguarding incidents were not always recognised, dealt with or reported to the appropriate authorities. The registered manager told us all staff had received safeguarding training. However, two staff told us they had received no safeguarding training and another said they had received safeguarding training five years ago.
Accidents and incidents were not always recorded correctly and there was a lack of evidence to show what action had been taken when these had occurred.
The registered manager confirmed they had received training in the Mental Capacity Act 2005 although our discussions with them showed they were not fully aware of their responsibilities under this legislation and they confirmed the staff had not received training in this subject.
Effective systems were in place which ensured people’s nutritional and health care needs were being met.
People’s care records did not always fully reflect their needs. Some people told us complaints they had raised had been resolved, whereas other said they had not. Although the registered manager told us they had dealt with any complaints raised, they acknowledged there were no records to evidence the actions they said they had taken.
We found a lack of strong leadership, ineffective quality assurance systems, weak communication and poor record keeping meant issues we found at this inspection had not been identified or resolved by the provider.
We found shortfalls in the care and service provided to people. We identified six breaches in regulations – regulation 18 (staffing), regulation 19 (recruitment), regulation 12 (safe care and treatment), regulation 13 (safeguarding), regulation 16 (complaints) and regulation 17 (good governance). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. 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
The overall rating for this service is ‘Inadequate’ and the service is 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.