Archived: Sanctuary Home Care Ltd - Tower Hamlets

Updated 15 February 2017

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.

The inspection took place on the 6, 7, 8 and 12 December 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. The provider knew we would be coming back the following days.

The inspection team consisted of two inspectors, one for all four days and the other for one day of the inspection. It also included two experts by experience who were responsible for contacting people during and after the inspection to find out about their experiences of using the service. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. The experts by experience had experiences as family carers of people living with dementia and older people who use regulated services.

Before the inspection we reviewed the information the Care Quality Commission (CQC) held about the service. This included notifications of significant incidents reported to the CQC and the report for the last inspection that took place on 10 July 2013, which showed the service was meeting all the regulations we checked during the inspection. We also asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We contacted the local authority safeguarding adults team and commissioning team and used their comments to support our planning of the inspection.

We called 44 people using the service and spoke with 19 of them, and seven relatives. We spoke with 18 staff members which included the registered manager, the regional manager, three team leaders, three care coordinators and 10 care workers. We looked at 13 people’s care plans, 12 staff recruitment files, staff training files, staff supervision records and audits and records related to the management of the service.

Updated 15 February 2017

This inspection took place on the 6, 7, 8 and 12 December 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. At our previous inspection on 10 July 2013 we found the provider was meeting the regulations we inspected.

Sanctuary Home Care Ltd – Tower Hamlets is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing personal care and support to 237 people in the London Borough of Tower Hamlets. All of the people using the service were funded by the local authority.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People who lived with specific health conditions did not always have the risks associated with these conditions assessed and care plans were not always developed from these to ensure their safety and welfare. Actions to manage risk that were recorded in risk assessments were not followed.

People received their medicines by staff who had received relevant medicines training however, information within people’s records was not always up to date and a number of issues were found with the recording of medicines and unexplained gaps. We could not always be assured that people received their medicines safely.

The provider had a robust staff recruitment process and the provider completed the necessary checks to ensure staff were suitable to work with people using the service.

The provider had a good understanding of the policies and procedures in place to safeguard people from abuse and avoidable harm. Incidents were reported and followed up and we saw evidence that disciplinary procedures were followed.

Staff had an awareness of the principles of the Mental Capacity Act 2005 (MCA) and care workers respected people’s decisions and gained people’s consent before they provided personal care. However, the service did not always ensure that where appropriate, representatives had legal authority to sign people’s care plans to agree with the care to be provided.

Care workers received an induction training programme to support them in meeting people’s needs effectively and were introduced to people before starting work with them. They shadowed more experienced staff before they started to deliver personal care independently. Staff received regular supervision and told us they felt supported and were happy with the supervision they received.

We saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs and social services. Issues that occurred were followed up with the relevant health and social care professionals.

People were supported to have sufficient food and drink and care records were detailed with regards to people’s preferred food however care plans did not always identify nutritional risks or needs.

People told us that staff respected their privacy and dignity and promoted their independence. There was evidence that language and cultural requirements were considered when carrying out the assessments and allocating care workers to people using the service.

People and their relatives told us that their regular care workers were kind and caring, gave them choices and knew how to support them.

An initial assessment was completed from which care plans and risk assessments were developed. Care was designed to meet people’s individual needs and was reviewed if there were any significant changes. However they did not always accurately reflect the care people received.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. There were quality monitoring visits and phone calls in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.

The registered manager told us that the service promoted an open and honest culture. Some staff felt well supported by the management team and were confident they could raise any concerns or issues, knowing they would be listened to and acted upon. However, other members of staff felt discriminated against. There were also morale issues due to the current uncertainty regarding the future of the service.

Quality assurance and management systems were in place to monitor the service however they were not always consistent as they did not pick up all the issues we found during the inspection.

We found three breaches of regulations relating to consent, assessing and managing risks and the safe management of medicines. You can see what action we told the provider to take at the end of the full version of this report