Revelation Social Care Ltd

Revelation Social Care is a domiciliary care agency. It provides the regulated activity personal care to people living in their own houses and flats in the community. At the time of our inspection there were 32 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Robust systems were not in place providing clear management and oversight of the service. The office area was disorganised and did not provide an effective working environment. Both electronic and paper records were inaccurate and incomplete.

The registered manager recognised the service was not equipped to support some of the people in their care. This was being addressed with the local authority. The registered manager also liaised with the local authority safeguarding team where issues and concerns had been raised.

Robust recruitment practices were not followed. Systems to support and develop staff did not ensure they had the knowledge and skills needed to support people safely and effectively. Some staff had worked excessive hours with inadequate breaks. This potentially placed the health and well-being of the service user and staff at risk.

People’s medicines were not managed and administered as prescribed. Staff training and assessments of competency had not been effective to ensure practice was safe. Information showed people had access to healthcare support, where necessary. We were told support to appointments was provided if needed.

Feedback from people and family members was very positive about the support provided and felt the registered manager was responsive. We were told staff enabled people to make their own decisions and offered choice when carrying out tasks. However, we found the service was not working within principles of the Mental Capacity Act. (MCA). Records did not clearly evidence capacity had been assessed and decisions were made in the people’s best interests.

People felt they were cared for in a safe way. However, staff felt, and records showed further development was needed, so staff were clearly guided in the support people needed to keep them safe. During the inspection, specific areas of training had been arranged for staff. This learning needed embedding and included within the individual support plans.

Suitable arrangements were in place to minimise the spread of infection. Records showed and staff confirmed training was provided in infection control. Staff told us personal protective equipment (PPE) was readily available and worn when carrying out care tasks. This was confirmed by people we spoke with.

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

Rating at last inspection

The last rating for this service was good (published 22 January 2019).

Why we inspected

We received concerns in relation to the management and conduct of the service, safeguarding, staff training and development and safe care and treatment, particularly in relation to risk management. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to consent, safe care and treatment, staff recruitment and training and good governance at this inspection. A warning notice has been issued in relation governance systems to ensure effective management and oversight of the service.

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.

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.

This service is a domiciliary care agency. It provides the regulated activity personal care to people living in their own houses and flats in the community. At the time of our inspection there were 3 people using the service.

At the inspection of the service in October 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff were not provided with accurate, up to date policies and procedures and effective systems were not in place to guide staff in the event of an emergency. The service was rated requires improvement overall. Following the inspection, we asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions, is the service safe and well-led to at least good.

During this inspection we found the required improvements had been made and the breaches of regulations had been met

The service had a continuity plan and effective systems were in place to guide staff in the event of an emergency. Where fire safety risks had been identified for one person the provider, the person and other agencies, including the fire service, had worked together to reduce the risks to the person.

The provider had a range of new policies and procedures, which were up to date and related specifically to Revelation Social Care.

The service is required to have 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 service had a registered manager, who is also the owner of the company.

People who used the service and staff spoke positively about the registered manager and their kindness and commitment. We found the registered manager to be passionately committed to providing good quality support and care.

People were very positive about the service and the way it was managed and organised. Staff we spoke with liked working for the service and told us they felt supported in their work.

Detailed assessments of people’s support needs and preferences were made. Risks to people had been assessed. Care records were person centred, detailed and reflected peoples support needs and what was important to them. All care records had been reviewed regularly and changes made when needed.

Medicines were managed safely. Staff had received training in medicines administration and had their competency checked regularly.

There was a safe system of recruitment in place which helped protect people who used the service from unsuitable staff.

Staff we spoke with were aware of safeguarding and how to protect vulnerable people. Staff were confident the registered manager would deal with any issues they raised. There were systems in place to protect people’s security and their property. People’s confidentially was maintained.

People who used the service told us they were consulted about the care provided and staff always sought their consent before providing support. The requirements of the Mental Capacity Act (MCA) 2005 were being met. People were supported to have maximum choice and control of their lives.

People told us the service was reliable and that visits were never missed. Visits were well planned and people usually knew in advance which staff would be visiting. There were sufficient staff to meet people’s needs and staff received the induction, training, support and supervision they required to carry out their roles effectively.

Suitable arrangements were in place to help ensure people’s health and nutritional needs were met.

Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

The registered manager had a system in place for reporting and responding to any complaints brought to their attention. People told us they had no complaints, but were confident any concerns would be dealt with promptly.

People were very positive about the staff who supported them and spoke about them fondly. People told us the staff were lovely, caring and cheerful. Staff knew people well and showed a genuine affection for the people they supported. Staff respected people and ensured their dignity was maintained.

There were effective systems in place to assess, monitor and improve the quality and safety of the service provided.

People who used the service were encouraged to give their views on the quality of the service they received and how it could be improved.

Records of accidents, incident and complaints were kept. The service had notified CQC of any accidents, serious incidents, and safeguarding allegations as they are required to do.

The provider had displayed the CQC rating and report from the last inspection on their website and in the office as they are required to do.

The service was last inspected in October 2016. At that inspection we found ten breaches in the Health and Social Care Act 2008 Regulated Activities Regulations 2014. These were in relation to the management of people’s prescribed medicines, recruitment procedures, staff training and development, risk management, quality monitoring, policies and procedures and care planning. This resulted in CQC taking enforcement action and imposing a condition to the provider’s registration. This condition states, “The provider must not provide any regulated activity to any further service users without prior written permission of CQC.” During this inspection we checked to see what action had been taken to address the breaches in regulation. We found that improvements had been in a number of areas.

Revelation Social Care provides help and support to people enabling them to remain in their own homes. The agency offers a variety of services in areas such as assistance with personal care, domestic tasks, help with medication and shopping. At the time of our inspection the service was providing personal care and support to three people.

The service has a registered manager, who is also a director of the company. 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.

During this inspection we found one breach remained outstanding in relation to the development of clear policies and procedures. In addition to a further breach in the Health and Social Care Act 2008 Regulated Activities Regulations 2014 has been identified due the arrangements to protect people in the event of an emergency.

You can see what action we have told the provider to take at the back of the full version of the report.

Some improvements had been made with regards to monitoring and assessing the quality of the service provided. Further work was required to ensure a robust system was in place which, demonstrated the provider had thorough oversight of the service and is able to evidence continuous improvements were being made to enhance the service.

Work was still required to ensure the agency policies and procedures reflected the practice of the service so that staff were clear about what was expected of them.

Relevant checks were made to people’s homes to help keep them and staff safe in the event of an emergency arising. However, contingency plans and fire safety records needed amending to ensure information accurately reflected the action to be taken in the event of an emergency arising so that people were kept safe.

Staff had access to relevant procedures and training with regards to the management and administration of people’s medicines. Whilst staff did not provide assistance with oral medication, support was provided with the application of topical creams We have made a recommendation with regards to the arrangements for ‘when required’ medicines, so that staff have clear guidance about when this is required.

We received positive comments from people and their relatives about their experiences and the care and support provided. Staff were described as being friendly, caring and respectful towards people and their relatives.

Systems were in place to ensure staff understood their responsibilities in protecting people from abuse. Staff spoken with demonstrated their understanding of the procedures and confirmed they were to attend planned training.

Relevant checks were in place for newly appointed staff. The registered manager was aware of the checks required prior to staff commencing work ensuring their suitability for the position so that people were kept safe. Sufficient numbers of staff were available to meet the needs of people.

Those people supported by the agency were able to make their own decisions about the care and support they received. People told us they were actively involved and consulted with in planning their support package. Staff were aware of the importance of seeking people’s permission before carrying out tasks. The registered manager was aware of their responsibilities under the Mental Capacity Act and information and training had been made available for staff.

A range of training and development opportunities were provided so that staff had the knowledge and skills needed to safely meet people’s needs. Staff we spoke with said they felt supported in their role and opportunities to improve their knowledge and skills were being provided.

Some people were supported in meal preparation so that their nutritional needs were met. Where people’s health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

People's care records provided sufficient information about their wishes and preferences and guided staff in the support people wanted and needed. Where risks had been identified, additional plans had been put in place so that staff could quickly respond to people’s changing needs.

The registered manager had a system in place for reporting and responding to any complaints brought to their attention. People and their relatives told us the registered manager and staff were approachable and would listen and respond if any concerns were raised with them.

Information in respect of people’s care was held securely, ensuring confidentiality was maintained.

The provider advised us that there had been no incidents, which would need to be reported to CQC. However the provider was aware of their responsibilities in reporting any such incidents where necessary. This information helps us check the service is taking action to ensure people are kept safe.

Pre-inspection information requested from the provider, which is required by law, had been provided to CQC as requested.

The CQC rating and report from the last inspection was displayed at the agency office as well as on the provider website.

At the time of the inspection there was 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.

This was the first rated inspection for this service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Medicines were not always managed safely. Competency checks were not undertaken to ensure staff were competent to administer medicines. Body maps were not in place to show where creams were to be applied. There were gaps in the medicines records which meant we did not know if people had been given their medicines. Medicine audits did not match our findings on the day of the inspection.

Recruitment procedures were not sufficiently robust to ensure people who used the service were safe. Records did not clearly show when information and checks had been completed. Dates were not recorded of when staff commenced employment.

The registered manager did not complete a rota to show what staff were on duty and where they were. They told us they knew where people were due to the small size of the staff team. However, they informed us that the local authority had told them these needed to be completed.

The registered manager was unaware of their responsibility to notify us of any serious injuries that occurred to people who used the service.

Staff were unable to tell us their responsibilities in relation to the Mental Capacity Act (MCA) or Deprivation of Liberty Safeguards (DoLS). Staff would not be able to recognise if people were being deprived of their liberty.

Staff had not received appropriate training or supervision to ensure people who used the service received care and support from staff members who were competent and skilled.

Information and guidance about how to complain was not available or accessible to people who used the service. The provider did not have an effective system in place to deal with complaints or show how these were being managed.

Care plans did not reflect the care and support being delivered or guide staff in their roles. Without clear and accurate information to guide staff, people are at risk of not receiving the care and support they need.

The service did not undertake quality assurance checks to assess and improve the service. Policies and procedures contained incorrect information and had not been reviewed.

Staff told us they had received safeguarding training and were able to describe the different types of abuse that they needed to be aware of. However, the staff we spoke with were unable to tell us what whistleblowing meant to them or how they would respond.

The service had communication books in place so that staff could communicate between themselves in relation to people who used the service. This should ensure information is shared between all staff members.

Staff members told us they always gave people choices and were able to give us examples of how they did this on a daily basis.

Staff were able to describe what equality and diversity meant and how they applied this in practice.

The staff we spoke with told us the registered manager was approachable and had a very visible presence in the service as they were included in the staffing numbers and worked as a carer six days per week.