9 June 2016
During a routine inspection
There was a registered manager in post. 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. The registered manager worked closely with a director of operations.
Staff had a good knowledge of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework to assess people’s capacity to make certain decisions, at a certain time. However, the registered manager was not clear on their responsibilities to ensure the service completed their own mental capacity assessments if it was thought a person may lack the capacity to make certain decisions. Where people were thought to lack capacity, assessments in relation to their capacity assessments had not been completed in line with the principles of MCA.
We recommend the registered manager seeks support from a reputable source around the MCA codes of practice.
People who used the service felt safe. The staff had a clear understanding of how to safeguard people and protect them from harm. Staff understood their responsibilities to report any suspected abuse. People and staff were confident they could raise any concerns and these would be dealt with. The provider had systems in place to manage and support safe administration of medicines. The service had sufficient numbers of suitably qualified staff to meet people’s needs.
People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.
People’s needs were assessed and care plans enabled staff to understand how to support people. Changes in people’s needs were identified through regular reviews. People's interests and preferences were discussed during assessments and these were used to plan their care. The service was flexible and responded positively to people’s requests.
People felt supported by competent staff. Staff benefitted from regular supervision (one to one meetings with their line manager) and yearly appraisals to reflect on their practice and develop their skills. Staff received training specific to people’s needs.
People and their relatives described the staff as good and providing very good care. People felt they were treated with kindness and their privacy and dignity were always respected. Staff had developed positive relationships with people.
The registered manager informed us of all notifiable incidents. The service had quality assurances in place. The registered manager had a clear plan to develop and improve the service. Staff spoke positively about the management and direction they had from the registered manager.
The registered manager had a clear vision for the service which was shared throughout the staff team. The vision was promoting independence and allowing people to live a safe normal life in their homes. This was embedded within staff practices and evidenced through people’s care plans. Staff felt supported by the registered manager and the provider.
Leadership within the service was open and transparent at all levels. The provider had systems to enable people and their relatives to provide feedback on the support they received. The feedback was acted upon when required.