Archived: I&A Homecare Services Limited

I & A Homecare Services Limited provide a personal care service to people in their own homes. The service provides a domiciliary care service throughout Accrington in Lancashire and surrounding areas. The agency office is staffed during the hours of 9:00 am to 5:00 pm, with a 24-hour on-call system for emergencies. At the time of our inspection there were 55 people receiving a service

We last visited I & A Homecare Services on the 26 November and 4 and 6 December 2015. During this inspection visit we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to a failure to ensure staff were trained and assessed as competent in safe administration of medication, failing to ensure staff received adequate training before they provided care and support and had regular supervision and a failure to effectively assess and monitor the quality of the service.

At the time of this inspection there was a manager in post who was currently applying to be registered as manager with the commission. 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.

During this inspection we found the service was meeting the current regulations.

There were appropriate arrangements in place to support people to take their medicines. People received their medicines as prescribed, by staff that had been trained to do this safely. People we spoke with told us their visits were arranged to ensure they got their medicines at the right time.

People using the service received care and support from a team of staff who had been recruited safely and trained to deliver safe and effective care and support. People we spoke with told us they felt safe from abuse or harm from the staff and they were treated with respect. They felt safe in their homes and they considered staff were trustworthy and respectful of their home.

People using the service and their relatives described the service as very good. They said staff were very respectful, attentive to their needs and treated them with kindness and respect when providing their support. Staff were also described in such terms as being caring and kind, very good and lovely people.

Safeguarding procedures were in place to guide and direct staff in reporting any concerns they had. Staff had been given basic training in safeguarding vulnerable people and knew what to do if they suspected any abusive or neglectful practice. Further training had been planned for. People we spoke with knew what to do if they had any concerns regarding the conduct of the staff who supported them.

Risks to people’s health, welfare and safety were managed very well. Risk assessments were completed and informed staff of the actions to take to support people safely. People knew they could contact the agency at any time and had emergency contact details for out of office hours. The service responded well to requests for urgent help.

Staff knew what to do in emergency situations and had guidance around keeping themselves and people they supported safe. Good arrangements were in place for staff to gain entry into people’s homes without placing them at risk. Staff were provided with protective equipment such as disposable gloves and aprons to minimise the risk of cross infection between people they visited.

Staff understood the principles of best interest decisions’ regarding people’s care and support and people’s diversity was embraced within their care plans. Arrangements were in place for staff to receive training in the principles of the Mental Capacity Act 2005. Care plans focused on the needs of people using the service. People’s right to privacy, dignity, choice and independence was acknowledged and respected.

Staff felt confident in their roles because they were trained and supported by the manager to gain further skills and qualifications relevant to their work. Staff were effectively supervised and were subject to spot checks to make sure high standards were being maintained at all times.

The service provided was flexible in meeting people’s needs. Visit times were scheduled to suit personal requirements and people we spoke with told us they could request a change of visit time and this was arranged. Assessment of people’s needs was an on-going process which meant any changes to their care was planned for. Changes to people’s needs and requirements were communicated well which meant staff were kept up to date with these changes.

People had opportunities to raise any issue of concern or pass on compliments about the service to the manager. People we spoke with had confidence in the manager to deal professionally with any complaint they raised.

People, their relatives and staff expressed their confidence in manager and felt the agency was very well managed. Staff performance was monitored well and staff were accountable for their practice. Tele monitoring was used to make sure staff were meeting their obligation in attending to people as and when required and ensure visits were never missed. Staff expressed job satisfaction and told us they felt valued.

We found there were good systems in place to assess and monitor the quality of the service, which included feedback from people using the service. Results of surveys completed showed a high satisfaction with the service people received.

I & A Homecare Services Limited provides personal care and domestic services to people in their own homes throughout Accrington in Lancashire and surrounding areas. The office is situated in Accrington town centre. At the time of the inspection the service was providing support to 89 people.

At the previous inspection on 08 January 2014 we found the service was meeting all the standards assessed under Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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The service was managed by 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.

During this inspection visit we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to a failure to ensure staff were trained and assessed as competent in safe administration of medication before they provided this support, failing to ensure staff received adequate training before they provided care and support and had regular supervision, failure to effectively assess and monitor the quality of the service to ensure any risk to people using the service was managed appropriately. You can see what action we told the registered provider to take at the back of the full version of the report.

We also made a recommendation about the importance of taking a more robust approach to the recruitment of staff.

People expressed satisfaction with the service provided and spoke very highly of the staff who supported them. People told us they felt safe. Their comments included, “I trust all my carers. I get the same carers visiting and I have never been let down. If there is a problem such as the carer running a little late they let me know”. And, “They do a great job. I have a team of usual carers so I have built up a good relationship with them and I feel I can trust them.”

People told us they felt safe in their homes when staff visited. They usually had the same carers who visited and considered this was important to them. Arrangements were in place for staff to gain entry to their home without placing them at risk. People told us staff were respectful towards them and their property. The agency had a code of conduct and practice that staff were expected to follow.

Recruitment procedures were generally followed to make sure staff were of good character and were suitable for the job. However we found that a more robust approach was needed when checking people’s employment history and with references being received. Arrangements were in place to maintain staffing levels to make sure people received their agreed care and support.

We found the arrangements for managing people’s medicines were not entirely safe. Not all staff supporting people with their medicines had been trained to provide this support. We also found staff were not competency checked to ensure they administered medicines safely. Records and appropriate policies and procedures were in place for the safe administration of medicines.

Clear safeguarding policies and procedures were in place at the agency office and staff were provided with guidance in the staff handbook. This helped to ensure the staff team were fully aware of action they needed to take should they be concerned about a person’s welfare.

The service worked alongside other service sectors. Where needed, advice was given to people regarding other professional support they could access, such as Occupational Therapist (OT) for aids, support to have a lifeline and the fire authority who offer a free fire risk home assessment.

Staff were provided with disposable gloves and aprons and hand cleansing gels to minimise the risk of cross infection.

People we spoke with felt staff had the right skills and knowledge to support them. People commented, “They are very good. We tend to get regular carers who know how we want things done. It takes time for relationships to be built up.” And, “The regular girls seem to know what to do and do it very well. They are usually on time. Sometimes a new carer visits but they are with one of the regulars who show them what to do.”

The service had good links with healthcare professionals such as GP’s and district nurses. One relative we spoke with told us, “Any changes the nurse wants, the staff will follow their guidance.” However one health professional and one relative expressed concern that inexperienced staff were turning up to carry out care duties they had not been trained in. We found induction training given to staff was not sufficient in providing staff with relevant knowledge and skills and staff supervision needed to improve.

People commented how caring staff were and described staff as being ‘very kind’ ‘caring’ and ‘nice people’. “They are very respectful. I never feel uncomfortable with them. We are on first name terms which makes me feel more relaxed. They are easy to get on with and nothing is too much trouble to them. They never leave without checking I’m all right.” People considered staff respected their right to privacy and dignity. Everyone we spoke with felt their carers listened to them and explained things in a way they could understand.

Care plans were being updated and those completed were well written and provided staff with enough information to care for people as they wished. Staff were kept up to date with changes to people’s needs and requirements. People told us the service was flexible and that any changes needed in their care or times of visits was managed well.

People using the service were confident to raise any concerns with management and to be confident any issues they raised would be dealt with promptly.

The registered manager had systems in place to monitor safety and quality across all aspects of the service which included feedback from people using the service. However, monitoring of the service needed to improve to make sure the service was fully compliant in all areas of safety and quality.

We spoke to four people who received a service and found people spoken with were happy with the care and support they received.

Care assessments and care plans were in place and these were followed in practice. We found that people usually had the same team of carers and people received confirmation of which staff member was visiting them before their care was provided.

We found that safe and effective recruitment processes were in place and that the service had a staff team that was appropriately qualified and experienced to provide a safe and effective service.

People who used the service were able to give their views about the service and had access to an appropriate complaints process. People's views were taken into account and they were therefore able to influence the delivery of their care.

We saw the results of the questionnaires completed in November 2013 and noted most people had a good level of satisfaction with the service. Where people had made any negative comments we saw examples of where the service had contacted the person to rectify any comments made.