Archived: Grove Domiciliary Care

At our last inspection carried out on 17, 27 and 30 June 2016, we found the service was in breach of seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (2014 Regulations) and one of the Care Quality Commission (Registration) Regulations 2009 (2009 Regulations). We served warning notices for breaches of four of the 2014 Regulations because people’s medicines were not being managed safely, there were no systems in place to monitor the quality and safety of the service, there were not enough sufficiently skilled and experienced staff to meet the needs of people and keep them safe, and the provider did not operate an effective recruitment procedure to ensure staff were suitable to provide care to people. We told the provider they were to be compliant with these warning notices by 16 December 2016.

At this inspection we found the provider had not met the warning notices because the service continued to not manage people’s medicines safely, systems were still not in place to monitor the overall quality and safety of the service, there continued to be insufficient staffing levels and staff were not sufficiently skilled and experienced to meet the needs of people and keep them safe. Recruitment checks remained incomplete prior to staff starting work.

We asked the provider to send us an action plan in response to the breach of three of the seven 2014 Regulations and one of the 2009 Regulations from the June 2016 inspection. We asked the provider to tell us what action they would take to meet people’s needs and keep them safe. This was because people’s needs may not have been met or met safely because care plans were not in place for people at the start of them receiving a service, safeguarding concerns had not been reported, identified and appropriately investigated, appropriate action had not been taken in response to complaints and the provider failed to notify the Commission of safeguarding concerns. The provider sent us an action plan on 5 October 2016, which stated they would be compliant with the Regulations by the 5 October 2016. At this inspection we found the provider had not met their action plan or the requirements of the Regulations because safeguarding concerns had not been identified and appropriately investigated and the Commission had not been notified of all safeguarding concerns received. Complaints were not investigated or responded to within given timescales.

Grove Domiciliary Care is a domiciliary care service, which provides care and support for people who live in their own homes in Fareham, Portchester, Warsash, Lee on Solent, Stubbington, Gosport and Portsmouth. At the time of this inspection, they provided care and support to an estimated 181 people with a range of needs including older people and those who lived with dementia. People were supported with personal care, medicines administration and meal preparation. The service employed a registered manager, a deputy manager, 74 care workers, three senior care workers, three care coordinators, two drivers who would transport care workers to visits who did not have their own mode of transport, and administrative staff based at the office premises.

The service had a registered manager. 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. However the registered manager had been absent from the service since the 30 November 2016 and the provider’s regional manager who was also the nominated individual of the provider was overseeing and managing the service in the registered manager’s absence.

The service had a registered manager. 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. However the registered manager had been absent from the service since the 30 November 2016 and the regional manager who was also the nominated individual was overseeing and managing the service in the registered manager’s absence.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

The service 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.

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.

Missed and late visits frequently occurred and staff were rushed resulting in poor manual handling techniques, incomplete care visits which resulted in neglect and care visits being too close together which resulted in people missing medicines and food and fluids.

People’s dignity was not respected as a result of missed visits because it was apparent the service expected relatives to complete people’s care when staff were unable to visit. People felt rushed and staff’s attitude to this demonstrated they were not consistently kind or caring.

Risk assessments did not contain sufficient information to keep people safe from harm and manual handling equipment was being used incorrectly.

Medicines were not managed safely. Records were unclear regarding the support people required with taking their medicines. There were gaps present on peoples Medicine Administration Records and people were not receiving the right dose of their medicines or their medicines at the right time.

Appropriate recruitment checks had not been completed for all staff prior to starting work.

Safeguarding concerns were not managed appropriately to keep people safe from harm. A number of safeguarding concerns had been raised against the service. However records relating to safeguarding concerns were not accurate or up to date. The Commission had not been notified of all the safeguarding concerns received by the service. The overall feedback from external professionals was that people were not safe from abuse or harm from this service.

Staff had not received appropriate training to help them to complete their role effectively and safely. Not all staff had not received practical manual handling training and not all staff had received training on medicines. Medicines competency checks had not been carried out on those staff who had completed the medicines training. Not all staff had completed training on the Mental Capacity Act 2005 and people may not have consented to their care plans.

People’s care plans were not personalised and lacked sufficient detail about how people would like to receive their care. Care plans did not include information on what people could do for themselves. Information contained within the initial assessments were insufficiently detailed, contradictory and unclear and were not always included in people’s care plans. Care plans in people’s home were out of date and did not contain the correct information.

The emergency out of hours service which was in place when the office was closed was not responsive and often switched off. Complaints had been received but were not investigated or responded to and there was no learning from complaints.

There was inadequate leadership within the service. People and staff did not feel that management were open and transparent and did not have confidence in the management team to deal with any concerns or issues.

The systems in place to assess the overall quality and safety of the service were inadequate and not fit for purpose.

People received support to seek advice from health care professionals. People felt listened to and

were encouraged to make decisions about their care.

We identified a number of breaches of the Health and Social Care (Regulated Activity) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

The Commission is considering the right regulatory response to the concerns we found.

Grove Domiciliary Care is a domiciliary care service, which provides care and support for people who live in their own homes. At the time of this inspection, they provided care and support to approximately 250 people with a range of needs including older people and those who lived with dementia. People were supported with personal care, medicines administration and meal preparation. The service employed 90 care workers which included six senior care workers who had each been delegated a specific geographical patch to manage. Their role was to oversee the care workers in their patch and cover on call out of office hours. There were also four care co -coordinators and administrative staff based at the office premises.

The service had a registered manager. 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. There were arrangements for managerial cover should the registered manager be absent.

At our last inspection carried out on 30 January, 6 February and 23 April 2015, we found the service was in breach of four regulations. Records had not been completed when people had been supported to take their medicines, safe recruitment practices had not been followed, people’s care needs had not been kept under review and the provider did not have an effective system to monitor the quality of service they provided. We asked the provider to send us an action plan to tell us how they would meet these regulations and what actions they would take to make improvements. The provider sent us an action plan on 8 July 2015, which stated they would be compliant with the regulations by the end of October 2015.

At this inspection we saw the provider had not completed all of these actions and we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

People who used this service often received missed or late calls. They told us that this had started to improve during the week from Monday to Friday, but that at weekends and holiday periods it was still very poor. This had put people at risk of harm especially those who needed support with their medicines, meal preparation or assistance to get out of bed.

Staff did not always recognise or report safeguarding concerns and the service did not take enough action to avoid further incidents.

There were not always enough staff to meet people’s needs, especially during weekends, holidays or in the event of staff sickness. People who had a regular named carer were the most satisfied with the service they received. We saw that the service had been trying to provide more people with a regular named carer.

Staff were not properly vetted before being allowed to work with people in their own homes.

When people were supported to take medicines staff did not always keep a record of this.

Staff did not receive enough training or supervision to meet people’s needs or to ensure people’s safety.

Although staff sought peoples consent before providing care and support, they did not demonstrate a good understanding of the Mental Capacity Act 2005, the associated code of practice and how this related to people they cared for.

People found staff were caring and told us that they respected their privacy and dignity.

People did not always have a written care plan at the onset of them receiving care. This had caused problems for staff and people who used the service and did not ensure that people received personalised care.

People’s complaints were listened to. However, the service did not learn from past complaints or people’s experiences in order to make the necessary improvements.

Staff found the registered manager supportive. However, the demands on the manager meant that important issues were not always dealt with and the manager did not always fulfil the legal requirements of a registered manager.

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, 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.

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 attempted to contact 24 people who used the service and spoke with 13.

We found that the service asked for people's consent before providing support and acted in accordance with their wishes.

Most people we spoke with told us that the care package had been set up by social services and they were happy with the care they received.

We found that the provider had effective systems in place to ensure that medicines were managed effectively.

We saw that the service had enough skilled, qualified and experienced staff that were supported appropriately to meet people's needs. Staff we spoke with told us they had enough time to support people.

The provider had effective systems in place to monitor and assess the quality of the service they provide. People were asked for their views and these were acted upon. Staff we spoke with told us they felt listened to and that the manager was supportive and responsive.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People said that the care workers were 'very reliable' and punctual.

People who use the service were protected from the risk of abuse because the agency had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

People were cared for, or supported by, suitably qualified skilled and experienced staff.

The agency had an effective system to regularly assess and monitor the quality of service that people receive.

There was an effective complaints system. Comments and complaints people made were responded to in a timely and appropriate way.