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Inspection Summary


Overall summary & rating

Requires improvement

Updated 9 September 2017

This inspection took place on 26 July 2017 and was announced. The provider was given notice because the location provides domiciliary care services and we needed to be sure that someone would be available to answer any questions. We contacted people who used the service and staff via telephone on 19 July 2017 prior to the inspection office visit.

Eldercare registered with CQC in January 2011 and is registered to provide personal care. Eldercare is based in Pickering and provides support to people in the community within the Ryedale area. At the time of this inspection there was 90 people using the service, most of whom were older people. The registered manager, who was also the company director and nominated individual was present throughout the inspection. A nominated individual is a person who is responsible for supervising the management of the regulated activity – personal care.

At the last comprehensive inspection in May 2015 we rated the service Good overall with the well-led domain requiring improvement. This was because there was not a registered manager in post.

At this inspection, we found that some improvements were required in the safe, effective and well-led domains. Quality assurance processes were not in place to monitor and improve the service. Some records had not been appropriately completed by staff and staff had not always received the required training.

We judged this to be a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager. 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 was supported by two office managers who took responsibility for the day to day running of the service.

People told us they felt safe. Staff understood and could describe action they would take if they suspected abuse was taking place. However, appropriate training had not always been provided.

Recruitment procedures were in place to ensure staff were safe to work and did not pose a potential risk to people who used the service. However, dates when such documentation had been received was not always recorded to evidence these checks had been completed prior to employment commencing.

Procedures were in place to guide staff on the safe administration of medicines and staff had received medicines training. The records we checked showed that people had received their medicines as prescribed. We found that the use of topical medicines was not appropriately recorded. We have made a recommendation about the management of this.

When risks had been identified appropriate plans were in place to support people safely. Although these provided only basic information, all identified risks had been addressed and provided appropriate advice for staff to follow.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005. Staff were aware of the procedure to follow if they suspected a person lacked capacity to make decisions, although relevant training had not been completed by all staff.

There was a process for completing and recording staff supervisions. New staff completed an induction before employment commenced and shadowed more experienced staff until they had built relationships with people. Appraisals had taken place for some staff but this was not consistent.

Training had not been completed for all staff in areas such as safeguarding and the Mental Capacity Act and some training had expired. A training plan was in place to ensure all training was up to date by the end of September 2017.

Some people who used the service were supported by staff with meal preparation and where possible people’s independence was promoted in this area. Records and people confirmed that they were given choice and were able to make independent decisions about what they had to eat and drink.

People were supported by a regular team of staff who knew their likes, dislikes and preferences. Staff had the knowledge of people’s personal histories and medical conditions and had been involved in implementing and developing support plans to meet people’s needs.

Care records contained evidence of close working relationships with other professionals to maintain and promote people’s health. People were clear about how they could get access to their own GP and other professionals and staff at the service arranged this for them where needed. People and relatives told us they were always treated with dignity and respect.

People usually consented to their care and support from staff by verbally agreeing to it. People we spoke with confirmed they had input into the planning of their support and had access to their care records. Information on advocacy services was available.

The provider had an effective system in place for responding to people’s concerns and complaints. People said they would talk to the manager or staff if they were unhappy or had any concerns and were confident any concerns would be appropriately addressed.

Satisfaction surveys had not yet been distributed to people who used the service to gain their views.

We found examples where the provider's quality assurance systems had not been effective in recognising and rectifying issues.

The manager and office managers were not fully aware of when notifications should be submitted to CQC. We directed them to guidance.

The provider had been requested to complete a Provider Information Return. This had not been returned within the required timescales.

Staff told us they felt supported by the management. They said the management team were approachable and felt confident that they would deal with any issues raised. Staff were kept informed about the operation of the service through regular staff meetings. They were given the opportunity to suggest areas for improvement.

Inspection areas

Safe

Requires improvement

Updated 9 September 2017

The service was not always safe.

Topical medicines, such as creams, had not always been appropriately recorded when administered.

Pre-employment checks on employees were completed that helped to minimise the risk of unsuitable people working with vulnerable adults. However, dates these checks had been completed were not always recorded.

Staff could explain indicators of abuse and the action they would take to ensure people’s safety was maintained although appropriate safeguarding training had not been provided.

Risk assessments had been developed and were in place when required.

Effective

Requires improvement

Updated 9 September 2017

The service was not always effective.

Staff had not always completed training that was relevant to their role.

Staff were supported with regular supervisions. However, appraisals had not always taken place.

Staff demonstrated good knowledge of the Mental Capacity Act 2005.

People were supported to maintain their health and had access to professionals, when needed.

Caring

Good

Updated 9 September 2017

The service was caring.

People spoke highly of the staff and said they were treated with dignity and respect.

Staff were knowledgeable about the likes, dislikes and preferences of people who used the service.

People were able to request change in visit times and this was accommodated.

Care and support was individualised to meet people’s needs. End of life care plans were in place when required.

Responsive

Good

Updated 9 September 2017

The service was responsive.

Pre-assessments had been completed before people began to use the service to ensure the provider could meet their care needs.

The provider had an effective system in place for responding to people’s concerns and complaints. People confirmed they knew how to make a complaint.

Care plans were detailed, personalised and focused on people’s individual’s care needs.

People, and where appropriate their relatives, were actively involved in care planning and decision making.

Well-led

Requires improvement

Updated 9 September 2017

The service was not always well-led.

Systems to monitor and improve the quality of the service had not been implemented effectively.

People had not been asked to provide feedback to improve the quality of the service provided.

The provider had failed to submit a Provider Information Return (PIR) to CQC as required within the required timescales.

Regular staff meetings took place and staff told us they were supported and included in the service.