18, 25 June 2014
During a routine inspection
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well-led?
This is a summary of what we found-
Is the service safe?
Two people we spoke with told us they felt safe when staff from Butterflies visited them to deliver care. However, we were aware of over eight safeguarding investigations where people had been put at risk and staff had acted inappropriately. This had led to action from commissioners and local social services to safeguard people using the service.
We saw staff had completed training in the safeguarding of vulnerable adults. Staff told us about different types of abuse and how they would recognise if someone was being abused. Staff knew how to report concerns to their line manager. The provider was aware of past concerns around reporting these on and had completed further training to improve their knowledge. Reporting of these events to Social services had improved. Appropriate checks were carried out on staff before they began working with people.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safeguarding people who use the service from abuse.
Is the service effective?
People we spoke with told us they were involved in planning their care. One person told us, 'I was able to identify when I wanted support and agreed with staff what they were going to do on each visit.' They told us, 'I am happy with the staff who support me in the morning and lunch time. I do not like the staff who support me at night. They are often late or hurried and on some occasions don't turn up'. Some care plans we saw in the office detailed all aspects of the care people should receive at each visit. However, a social care professional told us about a person who did not have a care plan in their home for over three months. This meant the person was at risk of not receiving care as the arrangements were not robust and care and support were not planned.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care and welfare of the people who use the service.
Is the service caring?
People were supported by staff who were aware of their needs and how they wished to be supported. One person told us 'I was happy with the majority of staff who visited me. They were very caring and kind and were like friends.'
However, we were aware of complaints received about staff turning up late, not spending enough time with people or delivering poor care. Due to the numbers of safeguarding concerns received people's experiences of care received varied from good to poor. We were aware of an incident where a person was administered a medication by a member of staff who had not been trained to give that medication.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in respecting and involving people who use the services and in the management of medicines.
Is the service responsive?
The provider was not always responsive. An assessment of needs was carried out before people began to receive support from the service. The care records contained details of how each person wished to be supported, including their personal likes and dislikes. However we found one person did not have a care plan in their home. People told us they could change some aspects of their care and could discuss this with staff or by ringing the office. One person told us of an incident where a member of staff had visited but the person had gone out and forgotten to cancel the visit. The member of staff had notified the office and phone calls were made to try to find the person.
People told us they had not received notification if staff were going to be late or not turning up at all. One person said, 'I know it was a Bank holiday but my night carers did not turn up. I tried ringing the out of hours number but nobody answered.' This had also been the case in some of the safeguarding concerns we had been made aware of. This meant the service had not been able to respond and were unable to attend when some calls had been missed.
We have asked the provider to tell us how they are going to meet the requirements of the law in relation to care and welfare of people who use the service.
Is the service well-led?
Staff told us the management team were supportive and always available for advice and help. Supervisions were occurring regularly. They said they received regular training and updates which recently included administration of medicines. Due to concerns around missed calls the provider had put in place a logging in system, used by all staff when they arrived at people's homes. This meant the office were able to monitor calls made and alerted them if staff were late.
However, we were aware the provider had not responded in a timely way to reported incidents or safeguarding concerns. This meant people were put at risk of receiving inappropriate care as action had not been taken to suspend staff whilst incidents were being investigated.
We had asked the provider to notify us of all safeguarding concerns around abuse. We had received one notification in a period where we knew more concerns had been reported to social services. The provider had not responded in a timely way to notify us of these events.
We have asked the provider to tell us how they are going to meet the requirements of the law in relation to notification of other incidents.