Sentinel Homecare provides a range of domiciliary care services to people throughout the Bradford area from an office close to the city centre. The agency provides care and support to a wide range of people including older people, people with a dementia related condition, and people with learning or physical disabilities. At the time of the inspection the service was providing care packages to approximately 230 people. The inspection took place between 28 November and 2 December 2016 and was announced. At the previous inspection in May 2015 we identified two breaches of regulation and rated the provider as ‘requires improvement.’ At this inspection we found improvements had not been made and the service continued to be in breach of these two regulations, as well as an additional three.
A registered manager was in place. ‘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.
Feedback about the service was mixed and had deteriorated since our previous inspection in 2015 with over half the people we spoke with raising significant concerns about late calls, calls cut short and a lack competency of some staff who delivered care and support. Although some people said staff were nice and friendly, other people said this was not consistently the case and they were not always treated with dignity and respect.
Most people said they received appropriate support with their medicines. However medicines were not managed in a safe or proper way as a complete record of the support provided to people was not kept.
People said they felt safe and comfortable around staff. We saw safeguarding procedures were in place and we saw evidence they had been followed and actions put in place to try and prevent incidents of this nature reoccurring.
Risks to people’s health and safety were assessed and clear and person centred risk assessments put in place for staff to follow. Some people said that staff did not always follow or were unfamiliar with risk assessments.
There were not sufficient quantities of staff deployed to ensure a consistent and reliable service. Although we saw most people got calls at an appropriate time, this was not consistently the case and some visits were cut short. Safe recruitment procedures were in place, although some people complained about the quality of new staff.
Staff received regular training, support and supervision. Despite this being the case, a number of people raised concerns about the lack of skill and competency of new care workers and lack of continuity of care workers.
The service was complaint with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent to care and treatment was sought and people told us they were given choices.
Overall, people received appropriate support to maintain good nutrition and hydration.
People’s healthcare needs were assessed and plans of care put in place for staff to follow. However late and short visit times had the potential to impact on people’s health.
We received mixed feedback about the attitude and behaviour of staff. Some people told us care workers were kind and considerate whereas others gave examples of staff not treating them appropriately. People said they were not always introduced to new care workers or informed if they were going to be late.
Information on people’s likes and dislikes and preferences had been sought as part of a person centred approach to care planning.
The service had taken the time to listen to people and record their comments or concerns. We found whilst effort was taken to resolve complaints, complaints surrounding areas such call time and length and reliability had not been fully addressed due to staffing shortfalls.
People’s care needs were assessed and clear and detailed care plans put in place. These were subject to review and people told us they felt involved in their care and support. In some instances we saw evidence care plans had been followed. However more than half of people told us care needs were not fully met. We saw call lengths were often shorter than agreed which in conjunction with the feedback we received led us to conclude staff had not always completed care and support tasks to the required standard.
People’s feedback was regularly sought, and the management team analysed it to help inform areas for improvement. However systems to assess, monitor and improve the service were not sufficiently robust as the service had deteriorated since the last inspection in May 2015, where we raised concerns over a number of areas of care and support. Systems had not been operated effectively to prevent the breaches of regulation we identified during this inspection.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities 2014) Regulations. You can see what action we told the provider to take at the back of the full version of this report.
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.