7 February 2017
During a routine inspection
The service was last inspected on 16 and 19 November 2015, at which time the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the inspection of November 2015 we identified the following breaches:
Regulation 17 (good governance)
Regulation 18 (staffing)
Regulation 19 (fit and proper persons employed)
During our inspection of 11 and 16 November 2015 we found staff were providing care for people without appropriate training, such as infection control and basic food hygiene. We also found staff had not received a thorough induction. At this inspection we found staff had received appropriate training to deliver care to people, and had undertaken an induction as described in company literature. The service was therefore no longer in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
During our inspection of 11 and 16 November 2015 we also found the provider failed to adhere to its own recruitment, induction and supervision policies in order to ensure employees were fit and proper persons. We found during this inspection that staff supervisions had taken place, that pre-employment checks occurred consistently and that gaps in employment were explored by the registered manager. This meant the service was no longer in breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Whilst we found improvements had been made in relation to ensuring care records were accurate, complete and contemporaneous, we found the provider had not implemented significant improvements to their quality assurance systems and they remained in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance.
My Homecare (Durham) is a domiciliary care provider based in Durham providing personal care and support to people in their own homes. There were 35 people using the service at the time of our inspection.
The service had a registered manager in place. 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.
There were sufficient numbers of staff deployed at appropriate times in order to meet the needs of people who used the service.
Staff underwent pre-employment checks with the Disclosure and Barring Service (DBS) and were clear about their safeguarding responsibilities. Other pre-employment checks were in place, including requests for references, ID checks and checks of gaps in employment. We saw that staff recruitment file audits had not taken place, despite being outlined as an action to be taken by the registered provider in an action plan sent to CQC after the previous inspection of November 2015.
We found that risks were managed and mitigated through pre-assessment and ongoing assessment. People using the service told us they felt safe and we saw that the service operated an out-of-hours phone line in case of unforeseen circumstances.
We saw that no medicines errors had been made on the Medication Administration Records (MAR) we viewed and medicines administration training was in place. Medicines audits were not consistent in their content or how regularly they occurred, meaning the registered manager would not be able to identify trends or patterns regarding medicines administration.
New staff received an induction which included introductions to safeguarding, dementia awareness, diabetes awareness, health and safety, fire safety, infection control and food hygiene. Additional mandatory training included safeguarding refreshers, dementia awareness, medicines management and infection control.
Staff files reviewed contained completed supervision documentation and staff we spoke with confirmed they received ad hoc and more formal support. We saw staff meetings happened intermittently. Auditing of staff supervisions and meetings had not taken place.
People were supported to meet their nutritional needs and preferences by staff who understood their preferences. People consistently told us staff helped them to choose their preferred meals and drinks.
People told us staff were on time, considerate and helpful. External professionals also told us that they considered the care provided to be to a good standard and staff we spoke with demonstrated a good knowledge of people’s individualities.
People contributed to their own care planning and were involved in reviews, with family members similarly involved. Where people’s needs changed, external professionals told us that staff worked with them to identify solutions and to ensure people’s needs could be met. People told us the service was accommodating to changes to visit times.
Personal sensitive information was stored securely and spot checks of staff undertaken checked to ensure they carried their identification badge with them.
People’s hobbies and interests were supported and encouraged through care plans that were person-centred to a degree. The registered manager agreed to improve the content of care plans to include more about people’s life histories, likes and dislikes, so that new staff would have a better idea of a person before visiting.
People we spoke with and staff confirmed they were introduced to their care worker in advance, and continuity of care was a positive theme from all people and relatives we spoke with.
The service had a complaints policy in place. People who used the service were made aware of the complaints procedure and told us they knew how to complain and who to, should the need arise. Complaints were responded to individually although auditing of complaints had ceased in July 2016, with the last Quality Assurance meeting between the registered manager and the business development manager.
People who used the service and staff told us the registered manager was approachable and supportive.
The service was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read more about the action we told the provider to take at the back of the full version of this report.