20 November 2018
During a routine inspection
This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. At the time of this inspection the service was supporting 32 people. Not everyone using the service receives regulated activity; the Care Quality Commission only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.
There was a registered manager at the time of our inspection, but they were no longer in day to day control of the service. A new manager had started at the beginning of October 2018. 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.
Appropriate arrangements were in place for the safe handling of medicines. However, the records relating to the administration of creams required strengthening. The management of people’s finances was not robust.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did support this practice. The manager told us best interest decisions were not in people’s care plans and we found mental capacity information was not easy to follow.
Some areas of the care plans contained person-centred information. However, not all areas of the care plans contained accurate information and some sections were blank or contained conflicting information.
The quality assurance monitoring system in place was ineffective in identifying areas for improvement. The recording of complaints and safeguarding issues was not robust. There was no analysis of accidents, incidents, safeguarding issues and complaints ensuring any trends or patterns were identified and acted upon. The provider’s action plan had not been effective in driving change.
People said staff always wore appropriate gloves and aprons for providing personal care. Robust recruitment processes were in place and followed, with appropriate checks undertaken prior to staff working at the service. Staffing level were sufficient to meet peoples care and support needs. New staff were supported in their role, which included training and shadowing a more experienced staff member. We saw evidence staff had received ongoing training. Staff had received regular supervision and ‘spot checks’ of their performance. There was a system in place to carry out annual appraisals.
People told us they were very happy with the service, staff were kind and caring, treated them with dignity and respected their choices. People told us they felt safe. Staff knew how to recognise and respond to abuse correctly. There were procedures in place to protect people from risk of harm and individual risks had been assessed and measures had been identified to reduce the risk.
Where required, people received support to eat and drink and with access relevant healthcare professionals. The service did not currently support anyone who was approaching the end of their life. There were mechanisms were in place to obtain feedback on the service from staff, people and relatives.
We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to governance arrangements and records. You can see what action we told the provider to take at the back of the full version of the report.