A healthcare regulator has taken “urgent action” after rating a domiciliary care service provider in Kent as ‘inadequate’. Following an inspection in June last year, the Care Quality Commission (CQC) made the decision to restrict the number of people being supported by the Initial Care Services South East Limited.
The service offers personal care in people’s own homes in Medway and the wider Kent area, including those with autism and learning disabilities. A focused inspection was carried out as part of the CQC’s checks on the safety and quality of services.
Following the inspection, the overall rating for the service – as well as the safety and well-led categories – were downgraded from ‘good’ to ‘inadequate’. The areas classed ‘responsive’, ‘caring’ and ‘effective’ also declined from a ‘good’ rating to ‘requires improvement’.
The service has now been placed into special measures which means it will be kept under close review to ensure people are safe while “sufficient improvements” are being made. And the CQC said it was looking to use its regulatory powers further.
Inspectors found people were not always supported to have the maximum amount of choice and control over their lives. They also said environment risks were not always managed safely due to staff “lacking guidance” on how to mitigate risks and respond to emergencies in people’s homes.
A spokesperson for Initial Care Services South East Limited denied carers were not trained, saying: “Carers were trained in both first aid and medication training, though this is online training. However, the inspector said the only acceptable training is physical training which was the first time I heard this.”
They added: “Immediately after the inspection, we looked for training centre to carry out a physical training for our staff and these have been done and certificates shared with the CQC. To say that carers were no trained on medication administration was totally not correct.”
Issues found by inspectors
Inspectors also raised issues around staff not always completing mental capacity assessments fully as “legally required for people that needed them”. This meant leaders could not ensure staff were supporting people in ways which still maximised their choices and respected their rights, the CQC said.
Responding to the findings, the service spokesperson said: “I will be happy if you (CQC) could share with me the law that mandatory “staff” (carers) to carry out mental capacity assessment as it is not the responsibilities of the carers to assess the service user’s mental capacity. It is the responsibility of the organisation to access the capacity of the service users if they are suffering from impairment of, or disturbance in the functioning of the persons mind or brain.
“And if none of this exist, we have to presume capacity at all level, except if it has been proven otherwise, support individual to make their decision. The decision has to support the service users and has to be in their best interest and the least restrictive one.
“The carers have been applying all these principles on daily basis and resulting in upholding the service user liberty. If the carers noticed any changes in service users cognition, then this will be reported to the office for an assessment to take place. However, if there is any law out there that said it is the responsibilities of the “staff” (carers) to conduct a mental capacity assessment, I will be very happy if you (CQC) can share this with me.”
Other issues found included governance systems and audits not being effective in identifying or addressing areas for improvement, the service not working collaboratively with external partners, such as the local authority, although it communicated well with people’s families and representatives when planning care. However, inspectors said people and their families gave positive feedback on their care and staff said they felt supported by the registered manager.
The service spokesperson added: “Since the inspection I have been cooperating with them and submitting every documentation requested to them without fail. Yes, there is always a room for an improvement just like any other organisation.
“Initial Care Services South East Limited take the safety of our service users to heart and always on ground to support both the service users and carers whenever we feel the extra support is needed as confirmed by both the family and carers interviewed during the inspection and we will continue to do the best for our service users.”
CQC deputy director of operations in the south Serena Coleman said: “When we inspected Initial Care Services South East Limited, we were concerned to find leaders weren’t managing the service well, causing safety issues which put people at risk of harm. Leaders weren’t providing staff with essential induction training like first aid and managing medicines, needed to keep people safe, or able to prove how they were supporting staff to keep those skills up beyond induction. Medicine records were unclear.
“The registered manager told us nobody using the service had support with medicines and they weren’t mentioned in people’s care plans, but we found people had been prescribed medicines. The culture of the service didn’t support people or staff to speak up about issues. Not all safeguarding concerns raised by staff and people using the service had been reported or investigated.
“For example, when one person had made a safeguarding allegation to a staff member, the registered manager chose not to report it or take further action because the person had raised a concern in the past which had been unfounded. This meant people weren’t always listened to, which put them at risk of harm.
“We restricted admissions to Initial Care Services South East Limited following the inspection and imposed conditions on the service in order to focus their attention on improving care for their existing clients before taking on anybody new. They are also in special measures and we will closely monitor the service to ensure that improvements are made and people are safe.
“We will return to check on their progress and won’t hesitate to take further action if people are not receiving the care they have a right to expect.”
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