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Inspection carried out on 10 January 2017

During a routine inspection

In Home Care provides services to people who live in their own home

At our previous inspection on 13 October 2014, the provider was in breach of two regulations that related to; Regulation 21 HSCA 2008 (Regulated Activities) Regulations 2010 Requirements relating to workers. The provider did not operate an effective recruitment procedure to ensure staff were suitable to provide care to people, and Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting staff. The provider did not have suitable arrangements in place to ensure staff were supported to deliver care to an appropriate standard by providing training and supervision.

After the inspection the provider sent us an action plan which detailed the steps they would take to meet the requirements.

At our announced inspection on 10 and 11 January 2017 we found the provider had made significant improvements and met the requirements.

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.

Staff and management consistently went the extra mile to provide outstanding care. People, their relatives and healthcare professionals told us the service was outstanding. Interactions between staff and people constantly showed an exceptional level of person centred care.

Management provided outstanding leadership, were constantly working to drive for improvement and always celebrated success. Feedback from all staff, relatives and healthcare professionals confirmed management were respected and led by example.

The registered manager had a good understanding of their responsibilities for sharing information with CQC and our records told us this was done in a timely manner. People and their families had been given information so that they knew what to expect from the service.

New legislation had been shared with staff which had been incorporated into the providers policies. Training had been reviewed and changed to reflect any new regulations. The service used the expertise of other recognised professional organisations to support practice development and continually improve the quality of service people received.

Staff told us that they felt their achievements were recognised and that they felt valued. Staff had a clear understanding of their roles and responsibilities. We observed staff were confident in performing their jobs and when speaking with people, other staff and the registered manager.

Audits had been completed and were linked to CQC’s regulatory standards of ensuring a service is safe, effective, caring, responsive and well-led. The audits effectively captured the level of detail sufficient to provide reliable data and lead to positive change. Audits and there outcomes were shared with staff at team meetings and through individual supervisions.

People who required assistance with their medicines were supported by appropriately skilled and qualified staff. They had received training and competency checks and had a good understanding of the risks associated with the medicine people were taking.

People, their families and other professionals told us they felt the service was safe. Staff had received safeguarding training and had their competencies checked. They were aware of the types of abuse that could happen to people, what signs to look out for and their responsibilities for reporting any concerns.

Risk assessments had been completed for people and their environments. Risk had been managed with the minimum restrictions on the people’s freedom and choices. Accidents and incidents had been recorded by staff and reviewed by the registered manager. This included reviewing risk assessments and updating care plans. Feedback was shared with staff to improve learning and practice.

Staffing levels met the needs of the people using the service. Staff had been recruited safely.

Processes were in place to manage any unsafe practice. We saw evidence that these processes had been used effectively.

New care staff completed the Care Certificate. The Care Certificate is a national induction for people working in health and social care who did not already have relevant training. Staff consistently told us the training they received supported them to meet the needs of people safely.

Staff received on-going training which was relevant to the people they supported. Training had included safeguarding, moving and handling, food hygiene, fire safety, infection control and dementia awareness.

Staff said they felt supported in their role. Staff told us they received regular supervision and had a yearly appraisal. Supervisions also took place with staff when they were supporting people. They included checking staffs dress code, their knowledge of the people they were supporting and any risks they lived with, health and safety and a check of record keeping.

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. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

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. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.

People had good access to healthcare. This included GP’s, district nurses, occupational therapists opticians and chiropodists.

People wherever possible had care workers who shared common interests and had gained the knowledge to understand people’s individual health challenges. They also had a good knowledge of people’s families and others important to them.

Care files included a privacy statement which explained to people the information that the service collected about them and why they kept it and staff understood their role in protecting a persons’ privacy.

People, their families and other professionals had been involved in a pre-assessment before the service provided any support. The assessment had been used to create care and support plans that addressed people’s individual identified needs. Staff demonstrated a good understanding of the actions they needed to take to support people.

People had their care and support plans reviewed regularly. Each week care workers were involved in a two way discussion with senior staff that included whether the time allocated to support a person was adequate, any equipment requirements, any professional input, and their feelings about the persons’ mental and physical well-being. Actions and outcomes from the discussions were recorded.

The service was pro-active in supporting people to feel part of their local community by promoting links with local businesses and events. People were supported to continue with activities they enjoyed.

A complaints process was in place. People and their families knew how to make a complaint and felt they would be listened to if they raised a concern. Complaints and there outcomes were shared with staff to reflect on practice and learn lessons when appropriate.

Staff were supported and encouraged to share ideas about how the service could be improved and had been pro-active in supporting changes. They spoke enthusiastically about the positive teamwork and support they received.

Inspection carried out on 13 October 2014

During a routine inspection

This inspection took place on 13 October 2014 and was announced. In Home Care Ltd provide personal care to people in their own homes. At the time of the inspection the service provided care to 38 people with a range of needs including those living with dementia, older persons and people with a learning disability. People were supported with personal care as well as more social support such as going out in the community.

At our last inspection on 27 November 2013 we found the service was in breach of a regulation as adequate checks were not carried out to ensure staff were suitable to work with vulnerable people. The provider sent us an action plan on 14 January 2014 to say this would be addressed by 14 February 2014. At this inspection we found the service was still in breach of this regulation as the provider had not requested written references from a staff member’s previous employers.

The service did not have 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 and associated Regulations about how the service is run. There was a newly appointed manager who was not yet registered with the commission.

People, and their relatives, said they felt safe with the staff. There were policies and procedures regarding the safeguarding of adults. Staff had a good awareness of the correct procedures to follow if they considered someone they provided care to was being neglected or poorly treated.

Care records did not always include guidance for staff to safely support people when providing care or supporting people to access activities in the community. We identified one activity where there was no care plan guidance about an identified risk when the person went out with staff.

Staffing was organised so that people received a reliable service. Comments from people included, “They do whatever I ask them to do and they are always on time twice a day.”

Pre employment checks were not complete for some newly appointed staff. This meant the provider could not be assured people received care from staff who were suitable to work with people.

People were supported by staff to take their medicines and this was recorded in their records. There were no checks that staff were competent to administer medicines or that staff were following the correct procedures.

Training, support and the induction of newly appointed staff was inconsistent. Staff told us they received training but other staff said they did not receive an induction and provided care to people before they received any training. For one staff member there was no record of an induction or supervision and for another staff member there was no record of any checks that the staff member was providing care to an adequate standard since they started work.

People had agreed and consented to their care. Whilst there were policies and procedures for those who were unable to consent to their care as set out in the Mental Capacity Act 2005, staff had not received training in this. This meant staff may not be aware of the legislation which needs to be followed if someone does not have capacity to consent to their care.

People were supported with meals and drinks. Arrangements were made to support people with their healthcare needs.

People said their needs were reviewed and they were consulted about the care they needed. One person said, “Yes I have a care plan and it is updated when things change.” People said they were treated with kindness and respect.

The provider used satisfaction surveys to ask people to give their views on the service they received, which the provider told us was used in reviewing the service. However, the management of the service was not monitoring the performance of staff to ensure they provided safe and effective care. The provider had also failed to provide information requested by the Commission on several occasions.

We found two 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.

Inspection carried out on 27 November 2013

During an inspection to make sure that the improvements required had been made

This visit took place to follow up two compliance actions made at the last inspection on 10 September 2013. The provider sent us an action plan to say the service was compliant by 28 October 2013.

We spoke to two staff and to the registered manager and the nominated individual.

We found the service had not fully complied with the previous compliance action by ensuring all staff were subject to a Disclosure and Barring Service (DBS) check before starting work, or obtaining a DBS Adult First check so that staff could work in a supervised capacity before working alone. Reference checks were obtained for newly appointed staff.

We found the service had an induction for newly appointed staff. We noted that the registered manager had trained staff in moving and handling and first aid when she was not qualified to train these subjects.

Inspection carried out on 10 September 2013

During a routine inspection

We spoke to three people who received a service from the agency and to a relative of someone who received care. We spoke to three staff about their work. On the day of the inspection we spoke to the manager and to two of the agency’s directors. We also spoke to three care staff employed by the agency.

Three people and a relative of someone who received a service from the agency said they were satisfied with the care and support provided. Reference was made by two people to how the agency was flexible in responding to people’s changing care needs. People said they were consulted about their care. One person, however, was not satisfied with the care they received and told us the agency had not responded to the referrals and contacts they made regarding arrangements for care.

We saw that people had care plans with details of the times care was provided and the support people needed. We noted that the agency was flexible in adjusting the times of care to suit people’s needs but this was not always reflected in the care plan.

The agency had policies and procedures regarding the safeguarding of vulnerable people.

The agency had not carried out sufficient checks on newly appointed staff. This included a lack of disclosure and barring service (DBS) checks and Adult First checks.

Staff had access to a range of training including moving and handling, the safeguarding of vulnerable adults and dementia care. We noted that training and induction was inconsistent. One person was employed to provide care without training or induction and a second staff member did not have a record of induction.