This inspection took place on 4, 5 and 8 May 2016 and was unannounced. This inspection was carried out to review the progress on meeting the regulations and shortfalls identified at previous inspections .We inspected St Anne's Community Services - Doncaster in February 2015 when we found two breaches of Regulations. These were regarding the safe management of medicines and lack of effective governance. The service received an overall rating of Requires Improvement following the inspection. We inspected the service again in November 2015. We did not find significant improvements at this inspection nor did we have evidence that where improvement had been made, they had been sustained or embedded to enable us to change the ratings given at the February inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘St Anne's Community Services - Doncaster' on our website at www.cqc.org.uk'
St Anne's Community Services- Doncaster provides personal care for adults with a learning disability in a supported living setting. The service is delivered in shared or self-contained community based accommodation in Doncaster. The service is divided into five separate teams each with a service manager. One of these service managers is also the 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.
At this inspection we identified continued shortfalls and repeated breaches of the regulations. The arrangements in place for protecting people from abuse or the risk of abuse were not sufficient to protect people, particularly from financial abuse.
Previous inspections in February and November 2015 had identified concerns in relation to medication which have not been addressed sufficiently. For example, we found two instances where prescribed creams were in use, yet did not have a medication administration record to capture the frequency or detail of application.
We saw that people’s risk assessments and support plans in relation to keeping people safe were generic and did not name the person they related to.
We spoke with staff about how they raised concerns to the provider. One told us that out of hours management was sometimes difficult to contact when incidents occurred. Another told us that they had raised concerns and did not feel the provider had responded.
We found the service was not meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). We spoke with the registered manager and other managers within the service about this. They believed that they could lawfully deprive people of their liberty, and spoke about making applications to do so. The Registered Manager lacked understanding of the legal requirements of the Deprivation of Liberty Safeguards in relation to support living services.
We found that the provider did not appropriately seek people’s consent, and on occasion obtained consent from other people on people’s behalf, despite them having the mental capacity to give or withhold consent themselves.
We checked records of staff training and found that the training programme was comprehensive, and enabled staff to undertake training in specialist areas that would enable them to better understand the needs of people using the service. Our observations during the inspection indicated that the training was not always put into practice or effective.
Staff meetings had not taken place at the provider’s required frequency, and topics discussed were limited.
We observed staff interacting with people and saw that they spoke with people respectfully and kindly.
Care plans lacked personalisation. In one part of the service, all the care plans were extremely similar, and did not contain individualised information and showed little evidence that people had been involved in their care.
There was a system in place for people to have a monthly meeting with their keyworker where their care plan and support was discussed. We found that such reviews had not always taken place in the three months preceding the inspection and in one instance the last recorded meeting was in October 2014.
Activities appeared to be plentiful, and people we spoke with described that they went out often.
A complaints policy and procedure was in place. People told us that they would be happy to raise concerns and would speak to staff or management if they needed to.
The arrangements in place for monitoring the quality of the service provided were poor. The service had a registered manager, however, the registered manager was only responsible for around 20 percent of the service; their role within the organisation meant they had no control or influence over the rest of the service.
The registered manager told us they carried out audits of care plans, audits of medication and checks of people’s finances. They were unable to describe any other areas they monitored. We found that care plan audits were inaccurate and did not reflect the records that we had checked.
We looked at statutory notifications submitted to CQC by the provider, and compared them to records of incidents that had happened within the service that the provider was legally required to notify CQC about. We found there were numerous incidents that the provider had failed to submit notifications for.
Some medication did not have dates recorded showing when it had been opened, and stock records were inadequate as staff had not recorded any medication carried forward from one month to another. This meant that the provider had failed to act when CQC found shortfalls in medicines management in November 2015.
In the months preceding the inspection, incidents had occurred within the service where money belonging to people using the service had gone missing. We found there were insufficient systems in place to protect people from financial abuse.
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 the 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 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.