17 October 2016
During a routine inspection
Care at Home Services provides care and support to a wide range of people living in their own homes including, older people, people living with dementia, and people with physical disabilities. The support hours varied from 24 hours a day to a half hour call and from one call to four calls a day, with some people requiring two members of staff at each call. At the time of the inspection 65 people were receiving care and support from the service.
The previous inspection of this service was carried out on 19 and 20 August 2015 when we found breaches of some regulations. At the inspection in 2015 we found that some improvements had been made since our inspection of 2014, but the provider was still in breach of three regulations relating to safe care and treatment, person centred care and good governance. There was a lack of oversight and scrutiny to monitor, support and improve the service. The provider did have suitable systems and procedures in order to assess, monitor and drive improvement in the quality of the service and the safety of people but these were not being adhered to.
The provider had not mitigated risks relating to the health, safety and welfare of people and had failed to ensure that people were protected against the risks of unsafe or inappropriate care arising from a lack of proper accurate records. The provider sent an action plan to CQC in October 2015 with timescales stating they would be compliant with the regulations by February 2016. At this inspection in October 2016, the provider had not completed all the actions they told us they would make and there was a lack of any significant improvements. As a result, they were still in breach of the regulations found at the last inspection and a further two breaches of the regulations were identified.
There was a registered manager in post who was supported by a deputy 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. The registered manager supported our inspection with the training and development manager on the first day of inspection and operations director the second day.
The provider had systems in place to audit and monitor the quality of service, including spot checks of staff, but these checks were not carried out consistently and effectively. The shortfalls found at this inspection had not been picked up by the registered manager had not been picked up by the registered manager.
People had opportunities to provide feedback about the service provided. Quality assurance questionnaires were sent out annually and the recent survey showed that people were satisfied with the service being provided. However, feedback had not been sought from staff and from a wide range of stakeholders, visiting professionals and professional bodies, to ensure continuous improvement of the service was based on everyone’s views.
At the last inspection in 2015 care and treatment was not provided in the safest way for people because the provider did not have sufficient guidance for staff to follow to show how risks to people were kept to a minimum. At this inspection minimal improvements had been made. Not all risks associated with people’s care and support had been assessed and guidance was not in place to mitigate risks to make sure people received safe care.
Medicines were not always managed safely when people were given their medicines by staff. Staff had not always signed the medicine records to confirm people had received their prescribed medicines. There was confusion about the level of support people needed with their medicines and this was not clearly explained in care plans so staff had clear guidance about how to give people their medicines safely.
People’s care plans varied in the amount of guidance and information they contained. Some care plans were not up to date and did not have all of the personalised information staff needed to make sure people received the care they needed. The care plans did not always include people’s preferred routines, skills and abilities so staff knew what people could do for themselves. People’s care plans did not always contain the guidance that staff needed to support them with their specific health care needs. People told us staff noticed if they were not well and supported them to call the doctor or community nurse if there were any health concerns. Some of the care plans did give information about people’s life history and some plans gave specific details about how people liked to receive their care and support but this was not consistent. People were supported to eat and drink enough.
People and staff told us how they always asked people for their consent before they provided care. People were supported to make their own decisions and choices about the care and support that they wanted. Some people chose to be supported by their relatives when making more complex decisions. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. Some people’s mental capacity had not been assessed to make sure that any care and support that they received was in their best interests.
People told us that they had complained at times about the service they had received. Although action had been taken to resolve individual complaints the management team had not logged these as complaints so they did not have oversight of the complaints raised to look for any patterns to try and prevent further complaints. Accidents and incidents were not always reported and recorded.
Staff practice not consistently monitored. Unannounced spot checks on staff competencies had not happened regularly to ensure they had the skills and competencies to perform their role. Not all staff had received regular support through one to one meetings and appraisals. Some people thought that staff were well trained and knew how to care for them, whilst others said that new staff lacked experience and they needed to enhance their skills to meet their needs. Staff had a range of training specific to their role and specialist training was provided. New staff were recruited safely. They received induction training, which included shadowing experienced staff and there was an on-going training programme in place.
There were mixed views from people about the consistency of staff who came to support them but on the whole people received a service from a team of regular staff and they said this had improved during the past months. Sometimes people needed to change the time of their calls to attend important appointments but said there was a lack of communication between the office staff and care staff team and people had missed their appointments.
At the time of the inspection the registered manager was in the process of recruiting new staff. There was enough staff available to give people the care and support that they needed. Permanent staff, including the office staff, deputy manager and registered manager, covered vacant hours or calls when staff were on annual leave. Staff had received training in how to keep people safe and demonstrated a good understanding of what constituted abuse and how to report any concerns. People we spoke with said they trusted the staff.
People told us the staff were good, kind and caring. People and relatives told us how staff made sure that people’s privacy and dignity were supported, and staff were polite and respectful. People we visited felt that staff understood their individual needs and they had built up relationships with them. People told us the staff were polite and kind. They told us that staff listened to what they wanted and always asked if there was anything else they needed before they left.
We found three on-going breaches and two further breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated requires improvement at the last inspection and remains requires improvement following this inspection.
You can see what action we told the provider to take at the back of the full version of this report.