Archived: Call for Care Limited

The inspection team was made up of one inspector and an expert by experience who had experience in mental health. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

People told us they did not feel safe. One person told us, 'Not wholly no, I still get minor incidents when I am being transferred to my wheel chair. It is a bit better now but it does still happen.' Another person said, 'Some of them don't understand English well and it is difficult.'

The provider did not have an effective system to regularly assess and monitor the quality of service that people received. We found there was no system in place that ensured lessons were learned from any accidents, incidents or near misses.

We found the provider had ensured there were sufficient numbers of staff to care for people. However, not all staff had received adequate training to be able to meet the needs of the people who used the service. We found gaps in training and competency in medicines.

The home had a policy and procedure in place in relation to the Mental Capacity Act 2005. We found people's consent was sought. However staff did not fully understand the principles of the Mental Capacity Act 2005 and not all staff had been trained. At our previous inspection in September 2013 we found the provider was not meeting these requirements. The service did not benefit from staff who understood how the impairment in mental capacity affected the person's decision making or ability to consent to care and treatment.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We found a number of gaps in the medicines charts with no reasons to explain the gaps. Most people told us they managed their own medicines. However, three of the 11 people we spoke with felt they were not appropriately supported with their medicines. One relative told us, '[Person] had been given the wrong dose.'

Is the service effective?

People's care needs were assessed, and care plans reflected people's current needs. We found assessments were being updated and were clear on what people's needs were. We found risk assessments had been updated and identified risks to people, who used the service, but staff had not received the necessary training in epilepsy, mental capacity and medicines to ensure people were cared for effectively.

Is the service caring?

Most people told us that staff were kind and caring. One person told us, 'Most are but they need to speak clearly so my relative can understand them.'

Is the service responsive?

We looked at complaint logs held by the service and we found that complaints had been received and responded to in line with the provider's policy. However, we saw evidence that the provider was not responsive to people's care and support needs. People told us they can speak to the office but very little was done about their concerns. One person told us, 'I called the office and spoke to a gentleman who said he will do something about it but nothing has happened.'

Is the service well led?

The service did not have a registered manager in post at the time of the inspection. The provider told us they would be applying for this role but did not fully understand domiciliary services. Members of staff we spoke with told us the manager did not listen and they did not feel supported. Members of staff we spoke with told us they were leaving the service because they did not feel listened to and felt the service was not managed effectively. People we spoke with told us the service was 'Messy' and 'Haphazard' and staff members told us the service was 'Unorganised and unsafe.'

The provider had a system to regularly assess and monitor the quality of service that people received. However this was not effective because people were asked for their views about their care and treatment but they were not always acted on.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others but there was no evidence that learning from incidents/investigations took place and appropriate changes were implemented.

The manager told us they had not received any reports of medicines errors from staff. However when we looked at the medicines record of four people who used the service we found a number of gaps present on their MAR charts that had not been explored or audited. The manager told us they did not audit medicines charts.

However, we found that care documents did not always provide clear information about the types of decisions people had capacity to make. We saw that where the care records detailed that a relative had the legal authority to make decisions on behalf of the person using the service, this information had been obtained in conversations and the registered manager had not seen paper work to confirm the detail of the conversation.

There were sufficient numbers of staff employed to meet the needs of people using the service.

People who used the service were protected from the risk of abuse, because members of staff had a good understanding about safeguarding procedures.

There was a process followed to assess the quality of the service provided, which included seeking the views of people who used the service, and make changes to improve the service.

We saw assessments had informed care plans however care plans were not written in detail and were without review dates. People were not always consulted about their care. We saw there was no evidence that a care plan which had a restrictive practice had followed appropriate Deprivation of Liberties (DOLS) guidelines.

People's health needs were not always met. We saw that risk assessments did not provide sufficient detail to ensure people's individual risks were managed or minimised.

People were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding vulnerable adults.

We saw staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of people.

Records we looked at showed the Provider had systems in place to monitor and assess the quality of service people received.