Archived: Sevacare - Tower Hamlets

Updated 31 August 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 12 and 14 April 2016 and was unannounced on the first day. On subsequent days the provider knew that we would be visiting the service.

The inspection was carried out by five inspectors, a pharmacist inspector and three experts by experience, who made telephone calls to people who used the service and their relatives. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to carrying out this inspection we reviewed information we held regarding the provider. This included notifications of events the provider is required to inform us of and the findings of recent inspections. In carrying out this inspection we looked at the care records of 21 people and other information relating to the delivery of their care, such as rotas. We spoke with 51 people who used the service or their relatives, including home visits to six people and their families. We offered to meet more people in their homes, however people told us that they had received visits from the Provider and local authority and did not wish to be visited further. We spoke with 19 staff and reviewed the staff and supervision files of 10 people.

Updated 31 August 2016

We carried out this unannounced inspection on 12 and 14 April 2016 as a result of concerning information we received about the service. At our last inspection in November 2015, we found a number of breaches of regulations in relation to safe care and treatment, person centred care, consent and good governance. The provider sent us an action plan stating what improvements they were going to make. During this inspection we found that the provider had not made adequate improvements in relation to consent, safe care and treatment and good governance. At the time of our inspection Sevacare Tower Hamlets was providing care to 348 people in their own homes in the London boroughs of Tower Hamlets and Haringey.

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.

We found that the provider had made improvements in their auditing processes since they were last inspected, however these had not been sufficient to pick up errors in care plans which did not always reflect the support that people actually received. We found that risk assessments did not adequately assess and manage the risks to people from ongoing health conditions and did not protect people from avoidable harm. There had been improvements in how medicines were managed, however we found that medicines given “as required” were not always appropriately recorded on medicines administration records and care plans. In some cases care plans did not document the support people received with their medicines appropriately.

There had been an improvement in the punctuality of visits, however lateness was still identified as a significant problem by many people who used the service and their relatives. Contributing to this was that rotas did not allow sufficient travel time between visits, and one of the teams did not have sufficient numbers of staff to provide the care that was required. In some instances, timesheets documented care that had not been provided.

The provider was not always following their own policies to ensure that safer recruitment processes were in place, and this may have posed a risk to people who used the service. Staff were checked and assessed for the quality of the care provided, however additional checks were not always carried out in response to concerns about staff members. Complaints were not always recorded and investigated appropriately in line with the provider’s policies, and people told us that concerns reported to the office were not always responded to.

Although measures were in place to ensure that staff had the training they needed, we saw induction and shadowing of new staff was not fully completed. There was insufficient assessment of the competency of new staff to provide care effectively.

The provider was not meeting their responsibilities to assess the capacity of people to consent to their care plans and demonstrate that they were working in line with people’s best interests, and managers did not always understand their responsibilities under the Mental Capacity Act 2005.

Most people we spoke with were happy with their care staff, and said that staff were kind and professional and respected their dignity and privacy. We saw that staff were reporting when they were concerned about people’s welfare and that appropriate steps were taken in these cases. People were asked their views on the quality of their care, and care packages were reviewed regularly.

We found breaches of Regulations with regards to consent, safe care and treatment, complaints, safer recruitment, staffing, good governance and display of ratings. You can see some of the action we told the provider to take at the back of the full version of this report. We are considering what further action we are going to take. 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 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.