Family Care Solutions

The provider of Family Care Solutions is a registered individual and this person was part of the management team. 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.

Not everyone using Family Care Solutions receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection the service was supporting 55 people with a regulated activity.

The inspection took place on the 9, 10 and 16 July 2018 and was announced to ensure that somebody would be available in the office to help us during the inspection.

The service was previously inspected in June 2016 and at that time was rated good overall. The service was rated as being good in the four domains of effective, caring, responsive and well-led and rated as Requires Improvement in the Safe domain. This was because we found the provider to be in breach of Regulation 12 safe care and treatment, as the provider was not taking reasonably practicable steps to reduce risks in relation to moving and handling. The provider was also found to be in breach of Regulation 19 as safe systems of recruitment were not being effectively operated.

Following the last inspection, we asked the provider to complete an action plan to show how they would ensure they met the regulations. The action plan detailed the arrangements made to ensure the service was compliant with Regulation 12 through providing moving and handling training on an ongoing basis for all staff. The action plan also detailed how the provider would meet Regulation 19 through the introduction of candidate evaluation forms and pre-employment checks. At this inspection we found the service was no longer in breach of these Regulations.

Care records contained clear detailed information and risk assessments in relation to moving and handling and there were policies in place to underpin the training required for staff. This included annual manual handling refresher training.

Systems to support the safe recruitment of staff were in place. We saw references and Disclosure and Barring Service (DBS) checks were being completed before a member of staff began working for the service. The DBS identifies people who are barred from working with children and vulnerable adults and informs the service provider of any criminal convictions noted against the applicant. These checks should help to ensure people are protected from the risk of being supported by unsuitable staff.

The service was continually recruiting and was aware that this would enable greater consistency for people. This would ensure that people were supported by staff who knew them and their care needs well.

There were policies and procedures in place to safeguard people from harm. Staff were trained to identify different types of abuse and respond to safeguarding concerns.

Assessments of people were undertaken and used to develop peoples’ care plans and risk assessments. Individual risk assessments were in place and documented actions for staff to reduce identified risk and promote peoples’ safety. Generic safety risk assessments in relation to the other aspects, such as laundry and clinical waste, were also in place. Care plans and risk assessments were reviewed regularly, and amended when there were changes in people’s needs. People told us they were involved in reviews of their care needs.

We saw records that demonstrated staff received training, supervision and spot checks. However, we could not be certain that supervision and spot checks were undertaken consistently. Staff told us that they had the training and support they needed to do their role.

There were policies for infection control, health and safety and food hygiene and we saw that staff received training in these areas. Staff told us they had access to personal protective equipment (PPE) such as disposable gloves and aprons and people told us that staff generally wore PPE when providing personal care. This meant that people were protected from the risk of illness through good infection control practices.

We looked at how medicines were recorded and administered to people requiring support with this task. We found that people were supported safely to take their medicine. We spoke with the service about best practice guidance during the inspection.

We saw that care records considered issues of dignity, respect and consent and there were policies in place to underpin these practices. People told us that staff were respectful and maintained their privacy and dignity and that consent was requested.

People who were supported with food and drink had care records that were detailed about how this support was to be provided. Monitoring charts for food and fluid intake were used when appropriate to ensure people identified at risk of dehydration and malnutrition were receiving adequate amounts to eat and drink. People were supported to buy food from suitable sources, which fitted with their preferences and religious beliefs.

There was a complaints procedure in place and concerns and complaints were recorded. We could see that the registered individual addressed these with people. However not everybody we spoke with was clear how to complain.

The service had systems for governance in place.

The service had good links to other agencies and worked closely with people and services to enable them to deliver a tailored package of care.

Family Care Solutions provide care and support to people living in their own homes. At the time of our inspection, the service was supporting primarily older adults living within areas of Stockport and Cheshire. The service was providing support to 58 people at the time of our inspection. The service was not required to have a registered manager. The provider was an individual who had responsibility for the day to day management of the service.

We last inspected the service on 27 January 2014 when the service was registered at a different address. At that time, we found the service was meeting the standards of the regulations inspected. At this inspection, we identified two breaches of the regulations, which were in relation to safe recruitment procedures and taking measures to reduce potential risks. You can see what action we told the provider to take at the back of this report. We made three recommendations, which were in relation to developing systems to monitor the safety and quality of the service, ensuring policies are up to date and recording of complaints.

People spoke positively about the service they received from Family Care Solutions. They told us the service was reliable and friendly and that staff were good. Staff told us they worked with the same people on a consistent basis and this was confirmed by the people we spoke with.

Staff, including managers were able to demonstrate that they knew people very well. We found staff and managers spoke about people in a kind, caring and respectful way.

There were sufficient numbers of staff to ensure all calls could be covered. We received one report of a missed call, however we were told this was not a regular occurrence. People told us staff turned up on time, or that there were only short delays, which could be due to traffic or staff being delayed on the previous call.

There was a generic, pre-populated risk assessment in people’s care files. These had not been personalised to individuals, so it was not clear that full consideration to potential risks had been given. However, we did see that where specific risks had been identified, such as in relation to self-neglect or behaviour that challenged, that additional risk assessments had been put in place.

Staff had received training in a variety of areas including infection control, safeguarding and the Mental Capacity Act. However, there was no recorded practical training in moving and handling and there were not always clear instructions in the care plan for staff to follow in relation to how to hoist people safely. Staff received an induction and were able to shadow more experienced staff until they felt confident prior to starting to lone-work.

People had care plans in place and there was evidence these had been reviewed and updated when required. There was no evidence of regular reviews if no required change had been identified. However, the provider had recently introduced a new electronic care management system, and we saw this had started to be used to help monitor and record when reviews were due or had taken place.

Staff told us they felt well supported and able to approach a manager with any concerns. They spoke highly of the quality of the service Family Care Solutions provided people.

People told us they would be confident to raise a complaint if they felt this was necessary. People we spoke with who told us they had made complaints said that any issues had been resolved quickly and to their satisfaction. The provider had not recorded informal complaints, so it was not possible to see what actions had been taken. They told us they had never received a formal complaint.

We saw staff had had a criminal records check before they started work. However, there were some gaps in records which would help the provider demonstrate that staff’s suitability for the role had been given due consideration. One staff member who had started shadowing other staff had started before references had been received and another staff file did not document the reasons for a gap in their employment history. We also found minutes from interviews had not been retained.

Staff demonstrated a good understanding of how to support people’s independence whilst balancing this against any potential risks. People told us staff always asked for their consent before providing care and were respectful of their privacy and dignity.

We saw the provider had researched good practice and sought advice from a professional in relation to providing effective support to meet a person’s needs. This had been used to produce guidance for staff.

There were some systems in place to help the provider monitor the quality and safety of the service. These were basic however and we have recommended the provider further develops these systems.

People, staff and the provider all talked about the benefits of the agency being small and local. For instance, we were told if someone rang the office, they would be talking with ‘the boss’ and they would work quickly to resolve any issues.