30 July 2014
During a routine inspection
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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
Forty eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available.
Somerset Care Community (South Hampshire) is a service that provides community services with personal care to older persons and people with dementia in their own homes. At the time of our inspection there were 300 people using the service and 96 members of staff.
At the time of the inspection Somerset Care Community (South Hampshire) did not have a registered manager in place. However, a manager had been appointed and they were in the process of applying to become registered with Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
Staff confirmed they were well supported and received training, induction, supervisions, spot checks by the provider of observing care being given and appraisals. However the provider was unable to produce records to evidence the training staff had received. As a result people may not be supported by staff who had the necessary skills and knowledge to meet their assessed needs.
There were not always sufficient numbers of suitable staff to keep people safe and meet their needs at the weekends. Risks to people were managed but staff did not always have the up to date guidance they needed to support people to balance risks as not all risk assessments had been updated following changes in people’s needs.
People told us they felt safe. One person said “I feel safe because I have known the main career for a long time.” However the service was not always safe because staff were unable to demonstrate an understanding of the requirements of the Mental Capacity Act (MCA) 2005 and did not know how to put them into practice.
People’s needs were assessed and they were involved in the assessment of their needs, but care plans and risk assessments did not always take account of people’s changing needs. Care plans were personalised but did not identify people’s goals and how they would be supported to reach their outcome. As a result people were not always being supported to maximise their independence.
People were encouraged to raise concerns about their safety. Staff showed an understanding of how to respect people’s safety when supporting people who experienced behaviour, which may challenge others. Staff demonstrated an understanding of how to recognise and respond to abuse. A thorough recruitment process was in place and staff disciplinary procedures were followed when the manager identified unsafe practice by staff.
People’s preferences were taken into consideration when they agreed to their care being provided. One person told us they had expressed a preference that no male carers provided their support. This was clearly recorded in their care plan and the person confirmed that only female carers supported them. People were supported to receive healthcare services and were involved in decisions about their nutrition and hydration needs which were monitored and managed.
Staff involved and treated people with compassion, kindness, dignity and respect. People told us, “They don’t pry and ask questions the carer knows and respects me.” People, and their relatives, were positive about the care and support provided by staff and staff actively sought, listened to and acted on people’s views and decisions. One person described staff, “caring but professional.”
There was a positive and open working culture where staff felt protected and supported to raise concerns and question practice. The management team were approachable and a number of changes had been implemented to improve the service. There was a system to manage and report, incidents, and safeguarding concerns. Detailed investigations had been completed when necessary to do so which sometimes led to action through performance measures for members of staff. CQC had been notified of relevant concerns. Quality assurance systems were in place and used to drive continuous improvements in service delivery. Complaints and concerns were explored and responded to in good time and used as an opportunity for learning and improvement.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.