27 January 2017
During a routine inspection
The service had an acting manager who had been in place since November 2016. They were about to start the process of applying to become the registered manager of 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.
There were some arrangements to manage medicines safely and appropriately. Records showed care workers had received medicines training and medicines policies and procedures were in place. However, we found the service was not completing Medication Administration Records (MARs) when administering medicines to people effectively. Medicine risk assessments were being completed for people however they did not state the reason for taking medicines and any risks and side effects. People were therefore at risk of not receiving their medicines safely.
There was a sufficient number of staff to provide people with safe support and care. However, some people and their relatives told us care workers did not always arrive on time. Most of the people and their relatives we spoke with told us the provider was not notifying them of care workers running late and if a different care worker was covering a particular shift.
People were confident on how to make a complaint. However, the provider could not demonstrate they had an effective system in place for handling of their complaints.
The provider had failed to submit statutory notifications relating to significant incidents that had occurred. A statutory notification is a notice informing CQC of significant events and is required by law.
Systems were in place to help ensure people were safe. Staff had undertaken training about safeguarding adults and had a good understanding of their responsibilities with regard to this. Risk assessments were in place which provided information about how to support people in a safe manner. Staff understood their responsibilities under the Mental Capacity Act 2005. Referrals were made to health and social care professionals when needed.
Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.
Care plans were in place detailing how people wished to be supported and people and their relatives were involved in making decisions about their care. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.
Staff told us they felt supported by the manager and the senior management team. Staff, people who used the service and relatives felt able to speak with the senior management team. The service had quality assurance systems in place. The service carried out audits of the service provision to ensure people’s views were gathered.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also one breach of the Care Quality Commission (Registration) Regulations. You can see what action we asked the provider to take at the back of the full version of this report.