A troubled dementia home care service in Ealing will be closing within days after a new management team failed to spark much-needed improvements.

Management at De Vere Care, which provides personal care to people with dementia and mental health issues, say they made the decision based on their own internal audit.

A Care Quality Commission (CQC) report concluded the service was ‘inadequate’ following a July inspection, just seven months after inspectors judged the service needed to improve.

Its latest report says the service will close if it does not improve – but a series of repeated failings left management with no choice.

De Vere Care in Ealing has been given a CQC rating of 'Inadequate'

A spokeswoman for De Vere Care told GetWestLondon: “Obviously we are very, very disappointed, there was a whole change of the management team in early January to work on these issues, so we have made the decision that we will be closing down the branch.

“Staff will not be losing jobs and we have sent a letter to all service users explaining the situation so they are all aware.”

She added the decision was made before the latest report was published and confirmed new management could not improve the service.

Users will be transferred to the care of another service provider in the borough, she said.

So what went wrong?

In two of five areas inspected, CQC inspectors rated the service as ‘inadequate’, which is the worst rating they can give.

The service ‘required improvement’ in each of the remaining areas and was ‘inadequate’ overall.

This means the service actually got worse after its January inspection when it ‘required improvement’ overall.

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On the most recent inspection, the report states: “During this inspection we identified multiple breaches of regulations.

“These included breaches we had already identified at the previous two inspections where the provider had made little or no improvement.

“This was because the provider did not have an effective management structure and leadership to support improvements at the service.

“There was also a lack of effective monitoring, assessments and actions being identified to improve the quality of the service and to meet the needs of the people using it.”

How does the CQC rate services?

The CQC inspects hospital, surgeries and other services across the country.

Inspectors give an overall account based on four different ratings – outstanding, good, requires improvement and inadequate.

Each inspection answers five key questions, these are:

  • Is the service safe?
  • Is the service effective?
  • Is the service caring?
  • Is the service responsive?
  • Is the service well-led?

Each question is answered with a rating from the choice of four and then an overall rating is given.

Poor safety

In one of the most worrying examples of the service’s lack of safety, not one incident or accident had been recorded since the service registered with the CQC in October 2015.

Inspectors found a number of missed calls in the complaints book and these should have been marked down as incidents.

This was despite inspectors already flagging this issue up in the January inspection.

The service didn’t follow its own procedures to make sure care workers were suitable and this put people in risk of “receiving unsafe care”.

Files contained checks and records including application forms, two references, identification documents with proof of permission to work in the UK if required and criminal record checks.

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Inspectors looked through six care workers’ files and found one who had no experience in care and had not worked in the UK had only two unverified character references.

The first check to ensure workers were doing their job competently did not happen until four months after this person was employed.

Worse still, the spot check template was not completed and the provider had not filled answers past question two.

Another care worker had an employment reference from the agency they last worked for but the reference had no stamp or official email address to confirm it was valid.

Examples reported by inspectors

Here are some of the findings highlighted by inspectors:

  • One person’s referral said ‘highly sensitive to latex so care worker must use alternative gloves' – but there was no risk assessment for the use of latex or how it was made sure care workers did not use latex gloves.
  • Another person was down as ‘doubly incontinent’ and on one day a week they were out in the community for several hours with a care worker. The ‘community engagement’ risk assessment did not state how the person’s incontinence would be managed while out.
  • A risk assessment for personal care said the care worker should use prescribed cream but there was no record of the cream on the medicines administration records or a body map to show where the cream should be applied.
  • One user wanted a care worker to arrive at 8am every morning but, over a two-week period, this care worker was on time just once – and showed up after 9am on all but two days.
  • De Vere’s supervision policy states a minimum of four supervision sessions a year but inspectors saw no evidence of four in a year and spot checks were “not consistent”.
  • The training matrix showed 15 out of 23 care workers had not completed adult safeguarding training in the past two years, ten out of 25 had not completed infection control training, 19 out of 25 had not completed moving and handling in the past year and 12 out of 25 had not completed Mental Capacity Act (2005) training in the past year.
  • In some cases, relatives had signed care plans on people’s behalf without legal authority, meaning “the provider did not demonstrate that people's rights and independence were always considered”.

Poor leadership

The registered manager for the service was on long-term leave from April 20 this year but the report claims plans for this absence weren’t made “in a timely manner”.

While the manager was away, the job was covered by the monitoring officer and care coordinator covered – who did not have the right training or management support.

Inspectors also criticised the service’s risk management systems and governance, concluding they did not always identify when a risk assessment was needed or if the risk management plan was robust enough.

The report states: “This meant the provider could not ensure a consistent quality of care to protect people from the risk of unsafe care and treatment.

“For example, risk assessments judged to put people at high risk when this clearly was not the case could have been restrictive because they might not have fully promoted people's independence based on the level of risk they faced.”

Time Line

De Vere Care's inspections

  1. October 21, 2016

    De Vere Care registers with CQC

  2. April 5, 2017

    De Vere Care's first inspection showed clear room for improvement

  3. January 9, 2018

    The second inspection showed no improvement

  4. July 16, 2018

    The service actually declined in its third and final inspection

De Vere Care provides personal care to people living in their own houses and flats.

It serves older people, some living with dementia, people with learning disabilities and people with mental health needs.

People’s care was funded by the local authority or privately. At the time of inspection, 20 people were using the service.