The inspection took place on 2 and 4 December 2014, and was an announced inspection. The manager was given 48 hours’ notice of the inspection. The previous inspection on 4 December 2013 was a follow up inspection, to look at previous breaches in the area of management of medicines. The provider had taken action and there were no breaches on the legal requirements at that time.
Park House Community Care provides care and support to adults in their own home. It provides a service to mainly older people and some younger adults and people who have a learning disability. At the time of the inspection it provided a personal care service to fewer than 20 people. It provided short visits to people as well as covering shifts over a 24 hour period to support people.
The service does not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 service had been without a registered manager since November 2013. At the time of the inspection the manager had started to put their application together to submit to CQC to register.
People told us they received their medicines when they should. However we found shortfalls in some areas of medicine management. Where people were prescribed medicine “as required”, there was a lack of proper guidance to enable staff to administer these medicines safely and consistently. Where people were prescribed “one or two” tablets, we were unable to ascertain what had been administered as staff had not recorded this detail. Staff were applying creams as part of personal care routines, but there were no proper records maintained. You can see what action we told the provider to take at the back of the full version of the report.
People felt safe whilst staff were in their homes and whilst using the service. The service had safeguarding procedures in place, which staff had received training in. Staff demonstrated a good understanding of what constituted abuse and how to report any concerns.
People had their needs met by sufficient numbers of staff. People received a service from a small team of care workers. People’s visits were allocated permanently to staff rotas and these were only changed when staff were on leave. Staffing numbers were kept under constant review.
People were protected by robust recruitment procedures. Staff files contained the required information. New staff underwent a thorough induction programme, which including relevant training courses and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role. However some refresher training had been delayed.
People were happy with the service they received. They felt staff had the right skills and experience to meet their needs. Staffs practice was monitored during unannounced checks on their practice. Staff felt well supported and attended supervision and team meetings.
People told us their consent was gained at each visit. People had also signed their care plan to confirm their consent to their care and support. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection and people had the capacity to make their own decisions although sometimes people chose to be supported by family members. The manager and staff had received or were booked to attend 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. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.
People were supported to maintain good health. People told us how observant staff were in spotting any concerns with their health. The service made appropriate referrals and worked jointly with health care professionals, such as community nurses.
People felt staff were “very caring” and “helpful”. People were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and knew people and their support needs well.
People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical or learning disabilities. Staff had built up relationships with people and were familiar with their personal histories and preferences.
People were involved in the initial assessment and the planning their care and support and some had chosen to involve their relatives as well. Care plans included people’s preferred routines, their wishes and preferences and skills and abilities. People said the manager or a senior member of staff visited periodically to review the care plan and discuss any changes required. People said their independence was encouraged wherever possible.
People told us that communication with the office was good and if there were any queries they called the manager and they always responded.
People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided both informally and formally. Feedback received had been positive.
People felt the service was well-led. The manager adopted an open door policy and took swift action to address any concerns or issues straightaway to help ensure the service ran smoothly.
The provider had a philosophy and vision. Staff were aware of these and felt the service listened and was very caring and promoted people’s independence, privacy, dignity and respect. Staff said they treated people how they would want to be treated.