5 June 2017
During a routine inspection
This inspection took place on 5 June 2017 and was announced. Cura Heart Wokingham provides domiciliary care services to people within their own homes. This includes a specific number of hours of support to help promote the person’s independence and well-being. At the point of inspection 10 people using the service received support with personal care. Cura Heart Wokingham is a newly registered service. The service was registered with the Care Quality Commission in December 2016, and began operating in January 2017.
The service has 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. The registered manager also holds nominated individual responsibility as he is one of the two directors of Cura Heart Wokingham.
People were not always kept safe. Whilst staff were able to recognise signs of abuse, they were unable to identify what protocols to follow if they had any concerns. As a result notifications were, not completed when safeguarding incidents occurred. The service did not complete or record any investigations to ensure that all steps were taken to prevent any abuse happening again
Risks were not assessed to keep people safe. This meant that staff did not always know how to manage a risk should one occur.
People were not supported with their medicines by suitably trained, qualified and experienced staff. Not all staff who administered medicines had received training in medicine management. There had been no check of staff competency prior to administering medicines. Some people had not received their medicines as prescribed. The impact and risk of this was neither reported nor assessed by the service. Staff were trained in medicine management by the registered manager. He did not have the necessary qualifications or skill basis to ensure competent training was provided.
The service did not have systems in place to ensure sufficient suitably qualified staff were employed to work with people. Systems were not in place to ensure that staff were safeguarded from harm to their health. The provider did not seek information related to staff’s physical and mental health prior to commencing employment.
People received care and support from staff who did not have the necessary skills and knowledge to care for them. Mandatory and specialist training had not been completed by all staff working with people, even though information provided by the registered manager prior to the inspection stated this had been completed. Staff did not have an understanding of the Mental Capacity Act, and did not know how to use the principles of this when working with people. People were not supported to have maximum choice and control of their lives. Staff may not have been able to support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
People told us communication with the service was not good and they did not feel listened to. Complaints were not investigated and not responded to. There was no evidence of any concerns being fully documented by the service, irrespective of issues being raised by the local authority.
People did not receive care that was person centred or tailored to meet their individual needs. Care plans did not contain sufficient information on how to support people, and were not reviewed. Calls were not completed for the full duration of the scheduled call. Staff were not allocated travel time between calls, which resulted in calls being shortened.
The service was not well-led. The registered manager did not have an overview of the service. Audits were not completed, nor the importance of these understood by the registered manager, as being an integral part in maintaining and developing the service. Information provided to the CQC was inaccurate and not reflective of the service.
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 were 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.