Background to this inspection
Updated
4 August 2023
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 Health and Social Care Act 2008.
Inspection team
This inspection was carried out by 3 inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 3 July 2023 and ended on 14 July 2023. We visited the location’s office on 5 July 2023.
What we did before inspection
We reviewed information we had received about the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 4 relatives of people receiving care about their experiences, 3 members of staff, the registered manager, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We contacted 2 healthcare professionals for their views about the service.
We reviewed care records for 5 people including medicines records, 4 staff recruitment files, training information, supervision records, quality surveys, incident records, safeguarding information, risk management plans, quality monitoring records and quality audits. We also reviewed policies and procedures.
Updated
4 August 2023
About the service
Serene Healthcare Group Office is a domiciliary care agency providing the regulated activity personal care. The service provides support to adults over and under 65 years, people with physical disability, sensory impairment and people living with dementia. At the time of our inspection there were 20 people using the service.
Not everyone who used the service received personal care. Care Quality Commission (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.
People’s experience of using this service and what we found
People’s medicines were not managed safely. Systems were not in place to check gaps in recording on people’s medicines records, which meant the provider could not be assured medicines had been administered. We found 2 people’s medicines were not being given following the prescribing instructions. We also found people with ‘as required’ medicines did not always have guidance in place for staff to follow.
Risks to people’s safety did not always have clear guidance in place for staff to follow. Some records had conflicting information about people’s needs and it was not always clear what action staff should take to keep people safe. Some staff had not been provided with moving and handling practical skills training or assessed for competence to carry out safe moving and handling tasks. The provider assured us practical skills training was booked for after our inspection.
Governance systems were not effective to identify shortfalls in care delivery and records. For example, medicines audits did not include a check of people’s medicines records. This meant the provider had not identified gaps in recording and taken corrective action. Some of the providers policies and procedures did not include using electronic care planning records. The complaints policy did not signpost people to the right agencies to escalate their concerns. We have made a recommendation about this.
There was a registered manager in post who was supported by the provider. There were systems to respond to safeguarding concerns. Staff had safeguarding training and told us they would report any concerns to their management teams. People were supported by enough staff and staff had been recruited safely.
Staff had induction training and were supported with supervisions and staff meetings. Staff had training on a variety of topics such as medicines, dementia and infection prevention and control. Staff told us they enjoyed their work and people and relatives told us staff were caring. There had been no missed calls.
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. People had their own electronic care plan which was reviewed regularly. The provider was in the process of changing their electronic care planning system during this inspection due to issues with connectivity. The provider was hoping the change would help them improve record keeping.
Staff were provided with personal protective equipment and training on infection prevention and control. If people needed help with meals staff were able to help with food preparation.
Incidents and accidents had been recorded and reviewed. Any measures needed to prevent incidents from reoccurring were identified and discussed with staff. All notifications for incidents or events had been submitted to CQC.
The provider carried out unannounced spot checks to monitor quality of care delivery. People were encouraged to share their views and had regular care reviews. Complaints were managed and actions taken to make improvement where possible. The service had received many compliments about care provided, particularly end of life care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 7 October 2021 and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment and good governance systems at this inspection. Please see the action we have told the provider to take at the end of this report.
We have made 1 recommendation about the provider’s complaints policy.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.