Archived: Age UK Dover Community Support

Updated 24 January 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 was 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 inspection took place on 7 and 8 December 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure we are able to speak with people who use the service and the staff who support them. On the 7 December 2016 we went to the office and looked at care plans, staff files, audits and other records.

We spoke with people using the service in the Age UK day centre. On the 8 December 2016 we visited three people in their own homes. The inspection was carried out by two inspectors and an expert 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. The expert by experience had personal experience of arranging and monitoring the domiciliary care services of a family member.

The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We gathered and reviewed information about the service before the inspection including notifications. A notification is information about important events, which the provider is required to tell us about by law.

We spoke with the registered manager, the consultant, two office staff and an assessor, who organised the work for the staff, plus four other members of staff. After the inspection we spoke with three people and six relatives by telephone. Feedback was gathered from one health care professional.

We reviewed people’s records and a variety of documents. These included eleven people’s care plans and risk assessments, four staff recruitment files, the staff induction records, training and supervision schedules, staff rotas, medicines records and quality assurance surveys.

The previous inspection of this service was carried out in January 2015 when four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. At this inspection, there were two continued breaches and one additional breach of the regulations.

Updated 24 January 2017

The inspection visit took place at the service’s office on 6 and 7 December 2016.

Age UK Dover Community Support is registered to provide personal care to people living in their own homes in the community. The support hours varied from half hourly calls upwards and ranged from one to three calls a day. The service office is based in the local Age UK day centre in Dover. They offer care in the Dover, Deal, Sandwich and surrounding areas, and support a wide range of people, including, older people and people living with dementia. At the time of this inspection there were 46 people receiving support with their personal care.

The service is run by a registered manager, who was present at the inspection visit. 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 and associated Regulations about how the service is run. The registered manager had overall responsibility for this service, as well as being the Chief Officer for the Age UK local branch. The registered manager was being supported by a consultant, two care co-ordinators in the office and a care assessor.

We last inspected Age UK in January 2015 when four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. The service was then rated ‘Requires Improvement’. The provider sent us an action plan telling us what they would do to meet the requirements of the regulations. At this inspection we followed up on four previous breaches of regulations. Two breaches had been met with two breaches of regulations only partially met and one additional breach was found at this inspection.

At the previous inspection in January 2015 the provider had not ensured that sufficient guidance was in place for staff to follow to show how risks were managed. There was a risk of people not receiving their medicines safely or as prescribed. People were not receiving care from staff that had the training, regular supervision and appraisal to carry out their roles effectively.

Risks associated with people's care had been identified, and detailed guidance was in place to ensure that people were supported as safely as possible. Some people could display behaviours that challenged due to their anxieties and detailed risk assessments were in place to guide staff to the strategies to adopt to positively support people when this occurred.

Although some improvements had been made to the systems in place to administer medicines safely there were still areas which remained unresolved. Staff were not recording individual medicines accurately and completing records properly. One staff member was administering medicines without any training or competency assessment to confirm they had the skills and competencies to give people their medicines safely.

The registered manager was carrying out audits on the quality of the service every three months; however these were not fully effective as the checks had not identified the shortfalls found at this inspection.

Staff had not been recruited safely, as the required checks had not been completed to ensure they were suitable to work with people. There was enough staff employed to give people the care and support they needed. New referrals were not being taken until new staff had been recruited. The registered manager told us that there was an ongoing recruitment drive to maintain staffing levels and improve the continuity of the service.

Staff training was up to date and there was a system in place to alert managers when staff needed training or further updates. New staff had induction training, which included shadowing experienced staff. Staff were supported by senior staff through regular one to one meetings and ‘spot checks’ to assess their skills and competencies to carry out their role. Each member of staff had received as appraisal to give them an opportunity to discuss their training and development needs.

Staff had received mental capacity training and ensured people were supported to make decisions. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. Deprivation of Liberty Safeguards (DoLs) provides a process by which a person can be deprived of their liberty, in a care home or hospital, when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. However, in domiciliary care these safeguards are only available through the Court of Protection. At the time of the inspection no one was subject to an order of the Court of Protection.

People were supported to make their own decisions and they told us their consent was gained at each visit. People and relatives had also signed and agreed with the care to be provided as part of their care plan.

People told us they felt safe when staff carried out their visits. Staff had received safeguarding training and were aware of how to recognise and report safeguarding concerns.

People were supported to maintain good health and appropriate arrangements were in place to monitor people’s health care needs. Care plans were person centred and detailed with personalised information staff needed to make sure people received the care they needed. The plans included comprehensive details of people’s preferred routines, their wishes and preferences, skills and abilities. People told us that they chose what they wanted to eat and were supported by staff to prepare their meals.

Staff supported people to go out and encouraged them to use local community facilities such as the Age UK day centre. They told us there were lots of people who visited the day centre and they enjoyed the social activities provided.

The provider had a complaints policy and process. Complaints were managed effectively and responded to appropriately, in a timely manner and in line with the policy. People and their relatives told us they would speak with the registered manager or staff if they had a concern and they would be listened to.

Some people had equipment in place to aid their mobility, such as bathing aids. Staff ensured that equipment that was kept in people’s homes was checked regularly and safe to use.

There was a business continuity plan in the case of an emergency, such as fire, flood or the breakdown of the technical systems at the agency office. There were on-call arrangements in place, which people and staff could access if they needed support outside of office hours.

People told us their regular carers were very kind and caring. They said their privacy and dignity were protected and they were encouraged to be as independent as they were able. Staff knew people’s daily routines and were polite and respectful, when talking about people they were supporting.

People told us that staff mostly arrived on time, stayed for the duration of the call, and always stayed longer if they needed more time. People received a rota of staff to confirm who was completing their visits and had never experienced missed calls.

Staff understood the visions and values of the service and they also understood the ethos of the service by treating people as individuals, with compassion, and with dignity and respect. Improvements had been made to ensure people were not protected against the risk of unsafe and inappropriate care arising from the lack of proper records.

We found a number of breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.