Background to this inspection
Updated
5 October 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 27 July and 3 August 2016 and the first day was unannounced. The inspection team consisted of one inspector.
As part of the inspection we looked at information we already had about the provider. Providers are required to notify the Care Quality Commission about specific events and incidents that occur, including serious injuries to people receiving care and any incidents which put people at risk of harm. We refer to these as notifications. A notification is information about important events which the service is required to send us by law.
We contacted other health and social care professionals for feedback about the service, including commissioners of care and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
We visited the Cornish Close site on two occasions where we spoke with the with the interim service manager, the divisional director, three team leaders and six care staff. We visited three bungalows on the larger site, observed the way people were supported in their accommodation and looked at records relating to the service. We spoke with five people using the service and three of their relatives.
We spent some time looking at documents and records related to people’s care and support and the management of the service. These included five care records, daily record notes, five medication administration records (MAR), maintenance records, audits on health and safety, records of accidents and incidents, policies and procedures and quality assurance records. We also reviewed the provider’s recruitment process and looked at staff files.
Updated
5 October 2016
This inspection took place on the 27th July and 3rd August 2016.
Cornish Close Domiciliary Care Agency was last inspected in November 2013 when it was found to be meeting all of the five standards reviewed.
Cornish Close Domiciliary Care Agency is registered to provide personal care and support to people with physical and learning disabilities along with associated mental health needs. People receiving the service live in one of the five bungalows in the grounds of a larger unit.
We were aware that the provider was in the process of changing the registered manager and an application had been made to this effect. The service had been without a registered manager for over a year. We had not been notified of this until May 2016. 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 provider had put interim measures in place in the absence of the registered manager.
Some people we spoke with had limited verbal communication. However, everyone clearly indicated they felt safe, were happy with the service and liked the staff.
Staff had received training in safeguarding vulnerable adults and could clearly describe the action they would take if they suspected any abuse had taken place. There was a safeguarding booklet in an easy-read format, available for people using the service. The booklet signposted people to organisations implementing equal rights for people with learning disabilities.
We saw that a number of incidents had occurred in the service during the last year. A number of medicines errors and a financial error had been reported to the local authority as safeguarding concerns but these had not been notified to the CQC. These incidents and some poor practices indicated that the service were not always safe.
Staff received training in the administration of medicines and recorded this on pre printed documentation supplied by the pharmacist.
The bungalows were clean and tidy and free from odour. There were effective health and safety checks in place. Staff had access to personal protective equipment (PPE) such as gloves and aprons and used them when undertaking personal care tasks and administering medicines.
The service had a safe system in place for the recruitment of new staff. There was a reliance on using agency staff at the service; however, the provider tried to use the same people for consistency. The company also had their own pool of bank staff to cover for regular staff absences.
An induction programme was in place for new staff to complete required training courses and shadow existing staff. Staff confirmed that they had completed training courses relevant to their role and felt confident in their role
People’s care records and risk assessments contained personalised information about their needs. The support plans we looked at included risk assessments, which identified any risks associated with people's care and had been devised to help support people to be as independent as possible.
If people’s needs changed a system was in place to liaise with the person, their family and other professionals to update care plans and risk assessments. Where required people’s health and medical needs were met, with access to GPs and other health professionals.
We found that the service was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. Staff could describe to us how their practices met the requirements of the MCA as they always sought people’s consent before they provided care and support. They followed instructions and guidance issued by health professionals and acted in the best interests of the person.
During our inspection we saw that staff were kind and caring. People were given time to do things at their own pace and offered encouragement from staff. We saw that staff knew the people they were supporting well.
People and their relatives were involved in the assessment and review of their care. Staff supported people to access the community and participate in activities that were important to them. Outside spaces had been developed by staff in front of people’s bungalows.
Staff told us that the upper management structure wasn’t clear given the absence of a long term registered manager and the further pending changes in management, but they felt supported by individual team managers of the bungalows. Team meetings were held and staff were able to raise any issues or concerns.
A system was in place for responding to complaints. We were told by relatives and staff that team managers were approachable and would listen to their concerns.
There was evidence of some audits and competencies of staff being undertaken at the service but we identified that overall, the systems in place to assess, monitor and improve the quality and safety of the service were not sufficiently robust.
During this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.