Background to this inspection
Updated
4 July 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 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 on 20 March 2017 and was announced. This meant that the provider and staff knew that we were coming. We did this, as the service is a domiciliary care agency and we wanted to ensure that appropriate staff were available to talk with us, and that people using the service were made aware that we may contact them to obtain their views. The inspection team consisted of two inspectors and two experts-by-experience. 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 the inspection we asked the registered manager to complete a Provider Information Return (PIR). This is a form that asks the registered manager to give some key information about the service, what the service does well and improvements they planned to make. Before the inspection we checked the information that we held about the service and the service provider. We used this information to decide which areas to focus on during our inspection.
During our inspection we spoke with 18 people, six relatives, six members of staff, the quality and performance manager, the regional manager and the registered manager. We reviewed a range of records about peoples’ care and how the service was managed. These included the care records for 15 people, medicine administration record (MAR) sheets, six staff training, support and employment records, quality assurance audits, incident reports and records relating to the management of the service.
The service was last inspection in July 2016 and received a rating of ‘requires improvement’.
Updated
4 July 2017
he inspection took place on 20 March 2017 and was announced.
MiHomecare – Woodingdean is a domiciliary care service based in Brighton and is part of a large corporate provider, MiHomecare. The service supports adults and people who are living with dementia or other conditions, to enable them to continue living in their own homes. Some people privately funded their care whilst others had their care funded by the local authority. At the time of the inspection 126 people were using the service, 120 of those were in receipt of the regulated activity of personal care.
The service had a registered manager. 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.
We carried out an announced comprehensive inspection on 16 March 2015. A breach of legal requirements was found and the service received a rating of requires improvement. We found inconsistencies in the systems in place to manage, monitor and improve the care and support provided to people, this included significant concerns in relation to on-going incidents of late and missed calls. Following the inspection the provider wrote to us to say what they would do in relation to the concerns found. On 25 July 2016 we carried out another announced, comprehensive inspection to check that they had followed their plan and to confirm that they were meeting legal requirements. At that inspection there was a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with regard to the monitoring, management and improvement of missed and late calls which were found to be frequent and on-going. We found breaches of legal requirements and the service received a rating of requires improvement. Another announced, comprehensive inspection took place on 20 March 2017, it was evident that improvements had been made and the provider was no longer in breach of the Regulations. However, there were areas of practice in need of further improvement and those that had been implemented were required to be sustained and embedded in practice.
Quality assurance processes had improved and there was more oversight of the systems and processes to ensure that people were receiving a service they had a right to expect. However, daily records and medicine records for people had not been audited in a timely manner to assure the registered manager that people were receiving their medicines and care on time and in accordance with their care plan and medication prescribing guidelines.
Improvements had been made since the previous inspection with regard to people being able to choose if they received care form a male or female member of staff. However, peoples’ preferences had not always been respected due to staff sickness and at times people had received care from a male member of staff rather than their preferred female member of staff.
People told us that they felt safe. One person told us, “Oh yes I feel safe with them”. Staff had received induction training and had access to on-going training to ensure their knowledge was current and that they had the relevant skills to meet peoples’ needs. People were safeguarded from harm. Staff had received training in safeguarding adults at risk, they were aware of the policies and procedures in place in relation to safeguarding and knew how to raise concerns.
There were sufficient staff to meet peoples’ needs and people told us that staff were kind and caring. One person told us, “The carers are very polite and kind. I can’t speak highly enough of them, everyone has been so kind”. People confirmed that they were treated with respect and dignity and their privacy maintained.
Risk assessments had been undertaken and were regularly reviewed. They considered peoples’ physical and cognitive needs as well as hazards in the environment and provided guidance to staff in relation to how to support people safely. People were protected from cross infection. People told us that staff maintained infection control by wearing appropriate personal protective equipment and regular observations by the management team ensured that this was maintained. There were low incidences of accidents and incidents, those that had occurred had been recorded and were used to inform practice. People received their medicines on time, they were administered by staff that had undertaken relevant training and who had their competence assessed. People had access to relevant healthcare professionals to maintain good health. People were supported with their hydration and nutrition and were offered support according to their needs and preferences.
Staff had undertaken training which the registered manager considered essential as well as training that was specific to peoples’ needs and conditions. People felt that the staff were well trained and felt confident that they had the right skills to meet their needs. One person told us, “They know their business”. A relative told us, “The carers are very professional in how they go about things”. People told us they were asked for their consent before being supported. For example, when being supported with their personal hygiene or to take medicine. The registered manager and staff understood that people should be supported to make their own decisions, and when people had difficulty with this, had involved the relevant people to ensure any decisions made were in the person’s best interests.
People were involved in their care and decisions that related to this. People were asked their preferences when they first joined the service and these were respected and accommodated. There were detailed, comprehensive and person-centred care plans that documented peoples’ needs and abilities. Regular reviews ensured that peoples’ care was current and appropriate for their needs.
A complaints policy was in place and complaints that had been received had been dealt with appropriately and in accordance with the providers’ policy. There was a friendly atmosphere within the service. People were complementary about the leadership and management. One member of staff told us, “I think so. The manager really listens. There’s always support if you need it, especially out of hours”. Another member of staff told us, “I think the manager is one of the best I’ve ever worked with. They’re honest and friendly but firm with it. Nothing gets missed”.