12 October 2016
During a routine inspection
The service is available on a flexible basis, in response to people's individually agreed support ¿package. At the time of the inspection the service was only providing personal care to one adult in ¿their family home. This was provided by a small team of three care staff; two full time and one part ¿time. This was the service’s first inspection following registration in July 2015.¿
A registered manager as responsible for the service. 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.¿
Care was provided in a safe and dignified way. Staff understood the risks to the person and their ¿care needs; they provided care in line with the person’s care plan. The person’s relative said, ¿¿“[Name’s] always happy to see staff. I’m always here when they help him. I’ve no concerns or ¿worries about any of the staff. They are all very good.”¿
Staff were caring; they had built a close, trusting relationship with the person over a long period of ¿time. A small team of staff provided consistent care; the staff cared for the person in line with their ¿cultural and spiritual beliefs. The person’s relative said, “We have [three staff who they named]. ¿We’ve known them for years really.” ¿
Staff had developed a close relationship and good communication with the person's ¿relative. The ¿relative felt their views were listened to and acted on. They would feel at ease and confident in ¿raising any concerns.¿
The person's legal rights in relation to decision making were upheld. The person and their relative ¿were involved in planning and reviewing their care.¿
Staff were trained, but did not always put their training into practice. There was a cultural issue in ¿the service which affected staff member’s work practice. Staff did not always work in line with the ¿service’s policies, vision and values. ¿
Staff had not been well supported through a time of significant change. Staff morale had been ¿adversely affected. One staff member said, “Very difficult, all the changes. You don’t always get ¿supervision or other support you need.” ¿
The management team did not work together effectively. The quality assurance processes in ¿place to monitor care and safety and plan ongoing improvements were not fully effective. ¿
The registered manager was committed to the improvement of the service. However, there was a ¿lack of management time to fully address and resolve issues. The registered manager said, “We ¿are not where we want to be” and “We do need a clear plan for the service.” ¿
Neither the cultural issues within the staff team nor the ineffective quality assurance systems ¿were having a direct impact on the one person who received personal care. However, there was a ¿clear risk their service may be affected if these issues prevailed.¿
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) ¿Regulations 2014. This was because staff did not receive on-going mentoring, support or ¿supervision to make sure they worked in a consistently effective way and did not always put their ¿training into practice. The management team did not work together effectively. The service’s ¿policies, vision and values were not always put into practice by staff. The provider did not have ¿effective systems in place to identify and ensure improvements needed in the quality of the ¿service were implemented. There was a lack of management time to fully address and resolve ¿issues. You can see what action we told the provider to take at the back of the full version of the ¿report.¿