Background to this inspection
Updated
31 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 checked whether the 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.
This announced inspection took place on 12 April 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to respond to our queries.
The inspection team consisted of one inspector and two experts by experience, who carried out phone calls to people and relatives using the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before we carried out the inspection we reviewed the information we held about the service. This included statutory notifications that the provider had sent us. A statutory notification contains information about significant events that affect people’s safety, which the provider is required to send to us by law. We reviewed the Provider Information Return (PIR). This is a report that asks the provider to give us some key information about the service, what the service does well and improvements they plan to make. We also spoke with the local authority for their views on the service.
During our inspection we spoke with six people using the service and nine relatives via the telephone. We also spoke with eight members of care staff, the registered manager, the manager for the service, a team leader and the regional operations manager. Five of the care staff we spoke with over the telephone and the remainder of staff we spoke with when we visited the service’s office. We visited the office on one day. At the office we looked at six people’s care records, the medicines records for five people, four staff recruitment files and staff training records. We looked at quality monitoring documents, accident and incident records, complaints, and other records relating to the management of the service.
Updated
31 May 2017
This announced inspection took place on 12 April 2017. Carers Trust Norfolk - Ketteringham Hall provides support to people in their own homes. It does not provide nursing care. At the time of our inspection the service was supporting approximately 64 people.
There was a registered manager in post. 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.
At this inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We identified a breach of Regulation 12 because sufficient actions were not taken to minimise the risk of medicines being unsafely administered. We also identified a breach of Regulation 17. This was because the provider’s quality assurance systems were not effective and had failed to identify the improvements needed. Additionally people’s care records did not always contain sufficient guidance and information for staff. You can see what action we told the provider to take at the back of the full version of the report.
People and relatives told us communication from the service could be improved at times, most of the people we spoke with did not know who was in charge and responsible for the running of the service. People and relatives knew how to complain and raise concerns. However, not all the issues people raised were sufficiently responded to or in a timely manner. People were involved in the assessing of their support needs but not all the people we spoke with felt they had the opportunity or sufficient frequency to review and discuss their needs.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. Staff and the management team understood the MCA and how this impacted on the support they provided. However, consent sought and recorded was not always taken in accordance with the MCA and documented. The registered manager told us they recognised some changes to their process were needed and confirmed plans were in place to rectify this.
People and relatives felt people receiving the service were safe. Risks to people were covered within care plans and separate risk assessments, however some of these lacked sufficient guidance for staff on how to manage individual risks to people. Staff demonstrated an awareness of adult safeguarding and knew how to report concerns.
People and relatives told us they were happy with staffing levels in the service and they did not receive missed or late visits. There was a system in place for office staff to monitor if staff were late or had missed a visit, which helped ensure visits were covered.
Staff were supported through training and supervisions to provide effective support to people. Staff spoke positively of the quality of training provided. New staff received an induction and support to ensure they were ready to work in the service.
People were supported to eat and drink where required. Staff made sure people had plenty of fluids available so they could stay sufficiently hydrated. Staff supported people to access healthcare services and monitor their health needs when required.
Staff understood the importance of providing support in a kind and caring manner, which included supporting the needs of people’s informal carers. People and staff had close caring relationships. Staff knew people well and this helped ensure people with non-verbal communication could make their needs and wishes known.
People were treated with dignity and respect, this included respecting and promoting people’s independence.
Staff understood the importance of promoting people’s social wellbeing alongside the support they provided. They told us they felt supported and involved in the running of the service.