Background to this inspection
Updated
28 July 2018
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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 14 and 15 June 2018 and was announced.
The provider was given 48 hours’ notice prior to the inspection visit. Prior notice is provided because the location provides a domiciliary care service and we needed to be sure that staff would be available on the day to support the inspection.
The inspection team consisted of one adult social care inspector.
Before the inspection visit we reviewed the information which was held about Just Care. This included notifications we had received from the registered provider such as incidents which had occurred in relation to the people who were being supported. A notification is information about important events which the service is required to send to us by law.
A Provider Information Return (PIR) was received prior to the inspection. This is the form that asks the provider to give some key information in relation to the service, what the service does well and what improvements need to be made. We also contacted commissioners and the local authority prior to the inspection. We used all this information to plan how the inspection should be conducted.
During the inspection we spoke with the registered provider, manager, managing director, quality control manager, seven members of staff, four people who were being supported and five relatives over the phone.
We also spent time reviewing specific records and documents, including six care records of people who were receiving support, six staff personnel files, staff training records, six medication administration records, audits, complaints, accidents and incidents, health and safety records, action plans, policies and procedures and other documentation relating to the overall management of the service.
Updated
28 July 2018
This inspection took place on 14 and 15 June 2018 and was announced.
Just Care is a domiciliary care agency. It provides care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the registered provider was providing support to 77 people.
Not everyone being supported by Just Care received personal care. A small proportion of people were supported with domestic duties, accessing the community and social needs. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks relating to personal hygiene and eating. Where they do we also take into account any wider social care provided.
There was no registered manager in post at the time of the inspection. A ‘registered manager’ is a person who has registered with CQC 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. The registered provider had appointed a manager in January 2017 but they had not submitted the relevant documentation to CQC.
At the last inspection in March 2016 the registered provider was awarded an overall rating of ‘Good’. However, we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe Care and Treatment). Following the inspection, we asked the registered provider to complete an action plan to tell us what changes they would make and by when. An action plan was submitted and we looked to see if the registered provider had made the necessary improvements.
During this inspection we found a number of improvements still needed to be made as the registered provider was found to be in breach of ‘Good Governance’. We are taking appropriate action to protect the people who are being supported by Just Care.
At the last inspection we found that medicine management processes in place were not safe. Recording procedures and the administration of medicines were not safely managed. During this inspection we checked to see if medicine management processes had improved. Whilst improvements had been made and the registered provider was no longer in breach of regulation in relation to ‘Safe Care and Treatment’ we found further developments were needed to this area of care provided.
Care plans and generic risk assessments were in place for each person supported. However, the risk assessments we reviewed were not tailored to the individual and records did not always contain the most up to date information. Quality assurance systems were not always effective in identifying areas of improvement which were required in relation to the quality and standard of care provided.
You can see what action we told the provider to take at the back of the full version of the report.
Staff were familiar with ‘Accident and Incident’ reporting procedures. There was an up to date ‘Accident Reporting’ policy in place although we identified that incidents involving medication were not routinely monitored. New documentation was implemented by the end of the inspection to ensure that all incidents involving medication were recorded and risk was mitigated.
Staff and managers expressed that they had recently experienced some problems with staffing levels. However, staff and people we spoke with expressed that staffing levels were well managed and people received a safe level of support they required.
Recruitment processes were safe. All staff had suitable references, the relevant applications had been completed, previous employment history had been established and disclosure and barring system checks (DBS) were in place.
Staff were knowledgeable in the area of safeguarding and whistleblowing procedures; staff knew how to report any concerns and who to report their concerns to. Staff had also received the necessary safeguarding training which meant that people were protected from harm and abuse.
Health and safety policies and procedures were in place. Staff were provided with personal protective equipment (PPE) and they were aware of the different infection prevention control procedures which needed to be complied with.
During the inspection we checked to see if the registered provider was complying with the principles of the Mental Capacity Act, (MCA) 2005. People’s ability to make decisions about the care they received was considered in line with principles of the MCA. However, we did identify that ‘consent’ to care documentation needed to be reviewed and updated.
Staff were supported and encouraged to develop their skills and abilities. Staff received regular supervisions and annual appraisals. There was also a robust induction package in place and staff received regular training and annual re-fresher training accordingly.
The day to day support needs of people was safely and effectively managed. We saw evidence of support provided by external healthcare professionals such as GP, district nurses, occupational therapists and dieticians. People received a holistic level of care which supported their overall health and well-being.
People’s nutrition and hydration support needs were effectively supported, measures were in place to mitigate risk and appropriate referrals were made to external healthcare professionals.
People expressed that they were treated with dignified and respectful care. People said that staff were compassionate, kind and provided warm and considerate care. Relatives also expressed that they always observed staff providing a high standard of care.
A person-centred approach to care was evident. Care records contained specific information about the people who were supported and staff expressed that they were able to familiarise themselves with the person’s preferences, likes/dislikes and daily routines.
There was a complaints policy and procedure in place. Complaints were responded to in line with the registered providers policy. People knew how to raise any concerns and were provided with the complaints process from the outset. People explained that if they did have any complaints or concerns they could confidently speak to staff or managers.
The registered provider had systems in place to gather feedback regarding the provision of care provided. People and relatives were encouraged to share their views regarding the quality and standard of care. This was done through annual questionnaires, care reviews and staff observations.
The registered provider had a variety of different policies and procedures in place. Policies were up to date and contained relevant information. Staff explained where polices could be accessed and the importance of following the guidance provided. Some of the policies we reviewed included medication administration, infection prevention control, safeguarding adults, equal opportunities and confidentiality.
There was a culture of warmth, kindness and compassion. Staff expressed that they felt supported by the managers and believed there was always an ‘open door’ policy operated. Staff explained that the managers and staff worked together as a team for the benefit of the people they were providing care for.
The registered provider was aware of their regulatory responsibilities and understood that CQC needed to be notified of events and incidents that occurred in accordance with the CQC’s statutory notifications procedures.