OFFICE

Updated 17 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was completed by 1 inspector and 1 Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post, who is also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. However, the registered manager was not present during the inspection process. We therefore spoke with the company director and the care manager. We formally wrote to the registered manager during the inspection to seek assurances on governance and oversight in their absence.

Notice of inspection

We gave the service short notice of the inspection. This was because it is a small service and we needed to be sure that a member of the management team would be in the office to support the inspection.

Inspection activity started on 9 June 2023 and ended on 28 June 2023 We visited the location’s office on 13 June 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider did not complete the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. Please see the Well-led section of the full inspection report for further details. We used information gathered as part of monitoring activity that took place on 21 February 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people and 2 people’s relatives to understand their views on the care and support provided. We reviewed 3 staff recruitment files, 6 people’s care plans and multiple call logs and medication records. A variety of documents relating to the oversight and governance of the service were reviewed, including audits, policies, and procedures. A specialist CQC team analysed data from the provider’s electronic call monitoring system. We spoke with 3 members of staff including the company director, the care manager and 1 care worker. We also sent out written surveys and received and reviewed responses from 4 care workers. We corresponded by email with the registered manager, who is also the nominated individual, as they were not in the country at the time of inspection.

Updated 17 August 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

OFFICE (known as Golden Hands Home Care) is a domiciliary care agency providing personal care. The service provides support to people with a physical disability or sensory impairment. At the time of our inspection there were 29 people using the service.

People’s experience of using this service and what we found

Right Support: Care visits were organised to suit staffing availability, and not to consistently meet people’s needs and preferences.

People were not always supported by staff of their preferred gender to meet their values and support a sense of dignity. Agency staff were not always aware of people’s specific needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

However, whilst regular staff promoted independence and considered capacity and consent, the systems in place at the service did not always enable staff to provide the right support.

Staff received an induction, mandatory training, and spot checks to support their development. Staff did not receive specialist training in supporting people with a learning disability and or autistic people. Some training was out of date.

Right Care: Whilst staff were described as being friendly, kind and compassionate, the service was not consistently person-centred due to provider shortfalls in oversight and monitoring.

Safeguarding measures were inconsistent, which meant people were at increased risk of harm or not receiving the right care. People told us they did not have access to their up-to-date care plan, or involvement in regular reviews.

Equality and diversity characteristics were considered as part of the care planning process.

People told us staff respected their privacy and independence.

Right Culture: The ethos, values, attitudes and behaviours of leaders did not ensure all people using the service could lead confident, inclusive and empowered lives.

Limited action had been taken since the last inspection to drive improvement at the service. Registered persons and the management team were not responsive to people raising concerns, or to professional feedback.

There was a poor understanding of legal and regulatory requirements. Systems for oversight and governance were absent, poorly developed, incomplete, or ineffective.

Whilst the management team completed care visits to people in their own homes, and were described as approachable, there was no robust strategic oversight for the service in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. At our last inspection we recommended that the provider fully explore all gaps in staff employment history during recruitment and keep a log of all missed calls at the service. At this inspection we found improvements had not been consistently made.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We carried out an announced comprehensive inspection of this service on 23 May 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance and oversight.

We undertook a focused inspection in relation to the key questions Safe, Responsive and Well-led to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found there were continued concerns about governance and oversight which impacted on other areas of the service, so we widened the scope of the inspection to become a comprehensive inspection, which included all of the key questions.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for OFFICE on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to dignity and respect, safe care and treatment, safeguarding people from abuse, governance and oversight and staffing. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We have issued the provider with a Warning Notice.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.