Background to this inspection
Updated
9 November 2018
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.
The office visit took place on 15 October 2018 and was announced. We told the provider we were coming so they could arrange to be there for us to review their care records and to obtain information about people and staff, so we could speak with them after our visit. This visit was a fully comprehensive announced inspection and completed by one inspector.
We looked at the information we held about the service and the provider. This included statutory notifications the provider had sent us. Statutory notifications are reports the provider is required by law to send us, to inform us about incidents that have happened at the service, such as an accident or a serious injury. Prior to this inspection visit, we received information that suggested staff teams were not always consistent and staffing levels affected when people received their care. We looked at this during this inspection and found staff recruitment and improvements to call rota management had improved the quality of care being delivered.
Prior to this inspection we asked the provider to complete a Provider Information Return (PIR). This is a form where the provider tells important information about the service and what they have identified requires improvements. We gave the provider a further opportunity during this inspection to provide us with information that shows what they have achieved since their last inspection. What the provider had recorded, was broadly what we found during this visit.
During the inspection visit on 15 October 2018 we spoke with the provider (who was the owner of the business and who also undertakes care calls to people) and the registered manager. The registered manager provided us with a list of people and relatives who they confirmed had given permission for us to speak with them. Following our office visit, we had telephone calls with three people who used the service and two relatives to seek their experiences of what the care was like from their point of view. We contacted five staff by telephone. Because of difficulties getting hold of them or being able to understand each other over the telephone due to language skills, we only spoke with one care staff member. This staff member was new to the service. Therefore, we have referred to staff’s abilities through the person’s experience rather than what staff told us. However, people told us they understood staff well when they supported them because they had got to know each other.
We reviewed care plans for two people including their daily records to see how their care and support was planned and delivered. We looked at other records related to people's care and how the service operated. This included the provider’s call monitoring systems, medicine records, staff training records and the provider’s quality assurance records. Quality records included provider audits, observed practice, staff recruitment files, staff supervisions and people’s feedback.
Updated
9 November 2018
An announced comprehensive inspection took place on 15 October 2018.
Victoria DomCare is a domiciliary care agency that provides personal care to people living in their own homes. Victoria DomCare provides a service to older people and some people who are living with dementia. At the time of our inspection visit they provided a service to 13 people. Care calls provided to people ranged from 7.30am to the last care call of 9.30pm. The agency currently supported people in and around the local geographical areas to Alcester. In addition to the registered manager and the owner (referred to in the report as the provider) who supported people with personal care, the agency employed five care staff with a new care staff member starting before the end of October 2018.
The management team had changed since the last inspection with one of the owners becoming the registered manager in May 2018. The registered manager felt they had better control of day to day activities now they were registered manager. They were confident of what they needed to do to ensure people continued to receive good standards of care. The provider and registered manager welcomed the inspection visit and assured us any recommendations would be acted upon.
At the last inspection in September 2017, the service was rated overall, ‘Requires Improvement’. This was because the provider did not always make sure there were enough staff to provide the care calls when people needed, and risks were not always managed safely. The quality assurance systems were not thorough and had not identified the improvements required. At this inspection we found that improvements had been made and the rating for this service had changed to Good.
At this inspection we have inspected all key questions to make sure all areas were re-inspected to validate the rating. Since our last inspection we received some information that continuity of staff was not always provided to people and the local authority had supported the service by reducing the number of care packages that had to be completed, in line with the available staffing numbers. Recent increases in care packages and staff recruitment showed improvements had started to improve staff consistency.
The office visit was completed by one inspector which took place on 15 October 2018 and was announced. We told the owner we were coming so they could arrange to be there and so they could contact people, to seek their permission for us to speak with them about their experience of using this service.
The service had 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.
There were procedures to keep people safe and manage identified risks to people’s care. People and their relatives felt safe using the service and staff, the registered manager and provider understood how to protect people from abuse and potential harm.
Where staff administered medicines, records showed staff were trained and assessed as competent to do so following their training. The provider’s recruitment process continued to ensure pre-employment checks were completed prior to staff starting work, to ensure staff were suitable to support people who used the service.
People said staff used protective clothing when needed, such as disposable gloves and aprons when providing personal care tasks, which helped minimise the risk of infection.
People had an assessment of care completed before they used the service with people and family involvement. This made sure staff could meet people’s care and support needs before care was provided. The provider put people’s needs first and if they felt they could not meet them when they carried out an initial assessment of needs, the care package was not accepted.
People said care staff stayed long enough to provide the care they needed and staff stayed for the required amount of time, unless people told them to leave early. People and relatives said care calls times were more consistent and care was provided by a regular group of more familiar staff. People were complimentary of staff and although people raised some concerns with language barriers, people said they had got used to each other so it was not a problem to them.
Care plans provided information for staff about people’s care needs and the details of what they needed to do on each care call. Relatives said staff completed daily records which showed what support their family member had needed. Relatives were confident with staff’s experience to care for their family member and relatives said they were kept informed of any changes.
The registered manager followed the principles of the Mental Capacity Act (MCA). People said staff respected decisions regarding their care and staff gained their consent before any care or support. Most people told us they had family members who worked with staff when complex care decisions were needed.
People told us they received care from staff who were kind, caring and considerate to their needs and they were treated respectfully and with dignity. Relatives were confident their relations were looked after well and for some, eased pressures on families knowing their relation was being cared for. Staff knew the people they visited and spoke about people in a caring and considerate manner. Newly employed staff were getting to know people and were first introduced before any care was provided.
People’s care needs were regularly reviewed and the registered manager and provider completed on the spot observations when care staff supported people. The registered manager and provider were in regular contact with people, or their relatives, to check the care provided was what people needed and expected. This was how the provider sought people’s feedback.
No one raised any complaints to us or the provider. People knew how to complain and information about making a complaint was available for people when they started using the service.
There was an ‘out of hours’ on call system, which ensured support and advice was available for staff to call, or people who used the service. The provider was contactable and available 24 hours a day.
Further information is in the detailed findings below.