Background to this inspection
Updated
2 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of one inspector and two experts by experience. An expert by experience is a person who has personal experience of using services or cares for someone who is older and/or lives with dementia.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. This service also provides care and support to people living in seven ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced.
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection site visit activity started on 02 July 2019 and ended on 16 July 2019.
What we did before the inspection
We looked at statutory notifications the provider had made to us about important events. In addition, we reviewed all other information sent to us from stakeholders for example the local authority and members of the public.
We used all of this information to plan our inspection.
During the inspection
During the inspection we contacted 62 and spoke with, 33 people and/or their relatives. Some people did not answer our call and/or chose not to provide feedback. In addition, we spoke with five members of staff, the registered manager, and the registered provider.
We also contacted Plymouth City Council adult social care commissioning team, and Healthwatch Plymouth for their feedback. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
We looked at four staff recruitment files, five care plans for people who used the service, policies and procedures, complaints, safeguarding and incident records, and auditing and monitoring checks.
Updated
2 August 2019
About the service
1st Call Home Care Limited is a domiciliary care agency which provides care to people over the age of 65 within Plymouth and the surrounding areas. The agency also has seven specialist supported housing units.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection the agency supported 250 people.
People’s experience of using this service and what we found
Overall, people’s risks associated with their care were now detailed in their care plans so staff knew how to support them safely. People told us they felt safe when staff entered their homes to provide care and support to them. Staff were knowledgeable about what action to take if they suspected someone was being abused, mistreated or neglected. Staff had been recruited safely.
People told us staff were kind and caring, but sometimes they experienced late visits and communication about staffing changes did not always happen. The provider told us they continued to work hard to rectify this, and recognised action and improvement was still ongoing.
People were protected by good infection control processes, and people now received their medicine safely.
People had their needs fully assessed when they started to use the service, so a care plan could be created, and care and support could be provided in a personalised way. However, once created, people told us they were not always involved in reviewing it.
Staff received training and support to be able to meet people’s individual needs. People’s human rights were now protected by the Mental Capacity Act 2005 (MCA) because their care plans now detailed their mental capacity. However, staff’s knowledge about the legislative framework was limited. The provider told us they would act to help improve staff’s knowledge and confidence.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Overall, people told us the service was well managed, however expressed a lack of organisation by office staff, at times, affected the overall quality of service delivery. The provider and registered manager had introduced a new governance framework to help highlight when improvements were required. But recognised the system still needed to be adjusted to ensure it was effective.
We recommended the provider strengthens their governance system, implements the care certificate as part of their induction process, and that they seek advice and guidance from a reputable source to improve staffs understanding of the Mental Capacity Act 2005.
More information is in Detailed Findings below.
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 19 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.