This inspection took place on 30 May 2018 and was announced.This was the first inspection of the service.
Prelle Healthcare is a domiciliary care agency. It provides personal care for people living in their own homes. At the time of the inspection the service was supporting 23 people for around 160 hours per week. When the service registered with the Care Quality Commission (CQC) they told us they would be providing services to younger adults or older people living with dementia, learning disability and/or autistic spectrum disorder, mental health needs, physical disabilities or sensory impairment. However, the registered provider was currently providing a service to older people with physical or sensory impairment or living with dementia.
There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.
The leadership and management of the service lacked understanding about meeting their responsibilities as a registered provider and manager. For example, the registered provider was operating in breach of their conditions of registration. This was because the registered provider was operating from a location address that was different to the address they had registered. They had not notified us of this, so the inspection was carried out at a different address than that identified on this inspection report. In addition, the provider had not notified CQC, as required by law, of any incidents which may potentially affect the safety and wellbeing of people using the service.
The registered provider did not have effective governance systems in place to continually assess, monitor and review the service so that required improvements could be identified and acted upon, including mitigating risks to people who used the service.
Despite concerns about the registered providers knowledge and effective governance systems most people told us they received good care and support.
We have made recommendations about care records so that staff had the information about how to best support the person and to reduce or eliminate the risks associated with their care and support. This included risks associated with the health, safety or wellbeing of the person.
The registered provider did not have effective recruitment processes in place. When staff were recruited, the system in place had not ensured all the relevant information and documents required were obtained before the staff member began working with people.
There was an insufficient number of staff to provide people with safe care and treatment and protect them from harm. The registered provider acknowledged the current staff team was insufficient to enable people to receive calls at regular times. This meant the registered provider was carrying out some of those calls to ensure calls were covered, but this had meant some of their other responsibilities as a registered provider had not been established or effective in practice.
Currently, the service was relying on training staff had received in previous roles so that they had the skills, knowledge and experience to deliver effective care and support. This meant that staff may not be aware of best practice or current guidance in care. Regular supervision for those staff was not established for the service to assure themselves staff were delivering effective care and support in accordance with their own vision and values and policies and procedures.
People who used the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, care records did not always contain information about people who had the legal authority to make decisions on behalf of the person where they lacked capacity.
There was a system in place to manage complaints, however, one person was not confident the registered provider listened and dealt with their concerns. We found a record was not made of the concern either as a complaint or incident. Other people and relatives said they had no cause to complain.
Staff were familiar with people’s individual needs and were able to describe how they maintained people’s privacy and dignity, which was confirmed by people who used the service and their relatives.
The inspection found one breach of the Health and Social Care Act 2008 Section 33 Failure to comply with conditions of registration, one breach of the Care Quality Commission (Registration) Regulations 2009 Notice of absence and four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
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.
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.