Artemis Domiciliary Care Ltd (Newcastle) provides personal care and support to people living in their own homes. At the time of our inspection there were 30 older people using the service who had physical, sensory or mental health related conditions. This inspection took place on 2 and 3 November 2016 and was announced. This was the first comprehensive inspection of the service since its registration in February 2015.
The service had a registered manager in post who was also the registered manager of another of the provider’s services based in Carlisle. 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 deputy manager operated the service on a daily basis. This was overseen by the registered manager who kept in daily contact with the service.
People told us they felt safe living at home with support from their care workers. Staff understood their responsibilities to report safeguarding concerns to the deputy manager or registered manager. People and staff told us they felt there were enough staff employed to provide a reliable and consistent service. We confirmed this through records.
There had been no accidents and only four incidents were recorded at the service; these were documented and forwarded on to relevant parties as appropriate, although formal analysis had not yet taken place to monitor patterns or trends.
The service had risk assessed general aspects of people’s daily living to ensure their safety, however the risk assessment documentation was generic and each person’s risk assessment contained the same risks and control measures. We discussed this with the deputy manager and registered manager who told us they would improve these documents and make them person specific. We have made a recommendation about this. The company policies and procedures had been recently reviewed and updated to support staff with the safe and effective running of the service.
Overall medicines were managed well. We found a small issue with the records involving topical medicines. People told us they had no issues with their medicines support and care workers told us they felt competent with this task. No incidents or near misses had occurred with regards to medicines support. Care workers had completed a safe handling of medicines training course and formal medicine competency checks were carried out.
The service had a good recruitment process in place; however, we found that in the three records we examined, gaps in applicants’ employment history had not been explored. The registered manager told us they would add this check into the interview process to prompt recruitment staff to explore this area thoroughly through discussion, making recruitment checking more robust. This had been implemented by the end of the inspection.
Staff received a company induction upon commencement of employment which included a briefing on company policies and procedures. However, in the three records we examined there was no evidence that a common induction package such as the ‘Care Certificate’ had been implemented in a timely manner. We discussed this with the registered manager who was able to provide evidence of other staff who had completed the Care Certificate. All staff had undertaken a mixture of face to face and online training courses throughout their employment. We found the process to ensure that all new staff had their skills and competence formally assessed, before carrying out their role unsupervised was not robust.
Formal staff supervision sessions, including shadowing shifts, a probationary review, one to one meetings and annual appraisals had all taken place. All staff had been spot checked during an unannounced visit from a team leader and plans were in place to conduct these periodically. Staff meetings were held every three months with the care workers and monthly management meetings took place. The staff we spoke with told us they felt supported and valued by the management team.
Evidence showed the registered manager and staff had an understanding of the Mental Capacity Act (MCA) and their own responsibilities. The service used the local authority’s mental capacity assessments within their records. Care records showed that wherever possible people had been involved in making some decisions, but significant decisions regarding people’s care were made in people’s best interests and had been taken appropriately with other professionals and relatives involved.
People told us they were respected and their dignity and privacy were maintained. All of the staff we spoke with displayed kind and caring attitudes and through discussion, they told to us how they respected people’s privacy and dignity.
People told us they received a responsive service from care workers who were familiar with their needs and preferences. However, we found support plans were not always person centred and the records we examined did not contain a sufficient level of detail about individual people to reflect a personalised service. People’s care needs were briefly recorded but did not always have a corresponding support plan or an individual risk assessment. Reviews were regularly carried out by the management team with input from people, their families and external healthcare professionals; however, care records were not always updated with any changes. We have made a recommendation about this.
People told us they were offered a choice in all aspects of the support they received and care workers told us they obtained verbal consent before providing any support. People and their relatives told us they had nothing to complain about but they knew how to complain and would feel confident to do so, if necessary. The service had received one complaint which we saw was being managed appropriately.
All of the staff told us they worked very well as a team. Care workers felt extremely well supported by the deputy manager who they described as approachable, caring and someone who made them feel like a valued member of the team. People, relatives and staff all described the service as “Excellent”.
The deputy manager told us they gathered feedback from people and relatives through regular contact on the telephone and when visiting people at home to update paperwork. Formal satisfaction surveys were carried out every six months which we saw portrayed positive results. The feedback we gathered as part of the inspection was very good from everyone we contacted. The service has not yet formally sought the views of its staff. The registered manager told us they would do this in the near future.
A robust system was not in place to thoroughly monitor all aspects of the service, including quality and safety. The issues we identified during the inspection highlighted this. We have made a recommendation about this.