Archived: Radfield Home Care - Cheshire

Updated 25 May 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place between the 3 and 7 April 2017 and was announced. We gave 48 hours’ notice because the location provides a domiciliary care service and the manager is often out during the day; we needed to be sure that someone would be in.

The membership of the inspection team was one adult social care inspector.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We also reviewed any information that we had received from or about the service in the way of notifications, questionnaires, compliments or complaints. We contacted the local authority commissioners who had no information to share in regards to this service.

We spoke with eight people who used the services over the telephone but also visited three others at home. We interviewed staff over the phone.

We looked at a sample of records for each person receiving regulated activity: this included care plans, daily notes, and care logs. We also looked at information pertinent to the overall governance of the service: this included staff rotas, recruitment files, spot checks, induction checks and training records. We also reviewed relevant polices, accident records, complaints/ compliments and quality audits.

Updated 25 May 2017

This inspection took place between the 3 and 6 April 2017 and was announced.

This was the first comprehensive inspection of this service since the office moved address.

The service provides personal care to people in their own homes. At the time of the inspection support was provided to 30 people.

There was 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. The service was managed day to day by a care manager and we were told she was responsible for oversight of the regulated activity.

At the inspection, we identified a number of breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People did not always receive support in line with their preferences and wishes. Some people told us that they did not receive a call at the time of day that suited them best and there were wide variations in their planned call times. Others told us that they felt uncomfortable receiving support from a carer of the opposite gender. Some people did not feel able to feed back their experience of the care they received.They said that they liked the staff and so did want it to reflect badly upon those individuals

People were involved in developing their care plan which staff could follow in order to provide the required level of support. These included people’s wishes and preferred routines as well as how staff were to ensure support was delivered safely. We found that changes in need, information about a person’s diagnosis or other pertinent risk factors were not always incorporated into the care plans. This meant that there was a risk that staff did not have all the necessary information available to them. Staff less familiar with the person may not be able to provide the right level of support.

People received support with their medication and care plans indicated the level of assistance required. There was sufficient information for staff to know how and when a medicine was to be administered or offered. However, mental capacity assessments had not been completed around people’s ability to make decisions with regards to medication or whether decisions had to be made in their best interest.

Staff had received training in aspects of their role that the registered provider had deemed as essential. New staff had undertaken an induction programme that followed the standards set out by the Care Certificate. Staff had not received training and observations to ensure that they were competent with all aspects of their role. Relatives told us they felt that some staff lacked in knowledge about specific medical conditions such as dementia, Parkinson’s disease or diabetes. Staff also undertook specialist procedures such as the taking of blood glucose readings with no assessment of knowledge and skill. Some medicines were given in the form of eye drops or inhalers but there was no record of staff having been assessed and observed as being competent to administer in this way. This meant that there was a risk that a person may not get these as prescribed.

There were quality assurance systems in place but these were not used effectively to monitor the overall safety and effectiveness of the service.

There was a lack of consistent and detailed information to allow a full and thorough audit of accidents and incidents. There was a lack of robust oversight to ensure the monitoring of missed, short or late visits. This was not embedded in the quality assurance system.

The registered provider had processes in place to ensure that staff underwent a number of checks prior to the commencement of their employment. This included the completion of an application, an interview, references and a check from the Disclosure and Barring service. However, steps were not always taken to ensure that the information provided was accurate and authentic. This meant that there was a risk that staff of unsuitable character or skill could be employed

People told us that they liked the staff that came to them and that they were treated with kindness. Staff had an understanding of safeguarding and how to recognise signs of abuse. However, the registered provider had not ensured compliance with the local safeguarding policy to report concerns around poor care. Staff took the time to get to know people and valued their personal history and background. Staff were able to describe to us how they ensured that people were treated with dignity and how they maintained their privacy during personal care tasks. Information about people was held safely and securely to ensure that confidentiality was maintained

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The registered provider had policies and systems in place to support this practice but they were not fully implemented. We made a recommendation that the registered provider ensure that they are able to demonstrate compliance with the principles of the Mental Capacity Act 2005. People told us that staff always asked their consent before undertaking any tasks. They also told us that staff did not prevent them from making unwise choices where they understood the risks.