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Inspection carried out on 24 July 2018

During a routine inspection

Prados Home Help Services provides care and support to people living in their own home. At the time of our inspection 17 people were using the service.

At our last inspection on 17 May 2015 we rated the service good. However, we found a breach of Regulation 11 of The Health and Social Care Act 2008. Need for consent. At this inspection we found improvement had been made and the provider was no longer in breach. The evidence we obtained continued to support the rating of good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The inspection was carried out on 24 July 2018 and was conducted by one inspector.

There was a registered manager at the service. 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.

People told us they felt safe when receiving a service at home and were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were sufficient staff available to ensure people's wellbeing, safety and security was protected. An appropriate recruitment and selection process was in place which ensured new staff had the right skills and were suitable to work with people living in their own home. Staff had a good understanding of systems in place to manage medicines and safeguarding matters.

People were supported to manage their medicines safely.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA).

People we spoke with said they were involved in care planning and were confident that their comments and concerns would be acted upon.

The provider took account of any complaints and comments to improve the service.

Risk assessments were in place for a number of areas and were regularly updated, and staff had a good knowledge and understanding of people's health conditions.

Feedback received from people who used the service and their relatives was overwhelmingly positive and people were encouraged to contribute their views.

People were positive about the staff who supported them and told us they liked the staff and were treated with dignity and kindness.

People were satisfied with the support they received in relation to nutrition and hydration. There was an open and transparent culture and encouragement for people to provide feedback.

People told us they were aware of how to make a complaint and were confident they could express any concerns which would be addressed.

Staff told us they enjoyed working for the organisation and spoke positively about the culture and management of the service. They also told us that they were encouraged to openly discuss any issues.

Further information is in the detailed findings below.

Inspection carried out on 7 May 2015

During a routine inspection

This inspection took place on 07 May 2015. The inspection was announced which means that we gave the provider 48 hours’ notice of the inspection to ensure key staff were available to speak with us.

Prados Home Help Services is a domiciliary care service which provides care and support for people who live in their own homes. At the time of this inspection they provided care and support to approximately 18 people with a range of needs including those living with dementia and older persons. People were supported with personal care, medicines and meal preparation. The service employed three care workers and a senior care worker. The provider also provided care to people.

People told us that being supported by the service made them feel safe. Staff sought people's consent before they provided care and support. Staff had a good understanding of safeguarding people.

Staff did not understand their responsibility under 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.

People’s care needs had been reviewed regularly. This meant there was less of a risk their changing needs would be overlooked.

We found medicines were managed well and staff understood their responsibility in relation to this.

Recruitment processes were robust and the service had carried out all necessary pre employment checks.

Care workers had the training they needed to meet people's needs and were caring and responsive. They treated people with dignity and respect and understood the need to maintain confidentiality. People were supported with meals and drinks. Arrangements were made to support people with their healthcare needs.

Care workers received appropriate support and supervision for them to carry out their role.

There were sufficient systems in place to assess and monitor the quality and safety of the service and to ensure that people received the best possible support. Complaints were dealt with appropriately.

At the last inspection on 27 August 2014 we asked the provider to take action to make improvements to safeguarding people, staff support and assessing and monitoring the quality of the service. These actions have been completed

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 29 October 2014

During an inspection to make sure that the improvements required had been made

This inspection was carried out on 29 October 2014 to follow up on a Warning Notice we served on 4 September 2014. This related to a breach of Regulation 21(a) (i) (iii) and (b) and Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider had failed to ensure people were being cared for by suitable staff because they had not undertaken suitable checks prior to the recruitment of staff. The provider sent us an action plan stating they would be compliant by 6 October 2014.

An inspector carried out a site visit to the provider's office and found that they had undertaken the actions outlined in their action plan and were now compliant with Regulation 21.

Inspection carried out on 27 August 2014

During a routine inspection

At the time of our visit we were told the agency was providing personal care support to 11 people. We attempted to speak with four staff and gained feedback from three members of staff. We also spoke with the provider and the person responsible for human resources. We reviewed the care records of three people. We spoke with three people who used the service and two relatives.

The inspection team was made up of two inspectors. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

People were asked to provide consent before they received care. People we spoke with told us the staff always supported and respected their decisions.

Staff understood the importance of respecting people and were able to describe how they did this and supported people’s right to make choices and remain independent. Care plans had been developed for people based on an assessment which involved the person. People’s support was planned in a way that was intended to ensure any identified risks were minimised.

People who used the service said they felt safe. One said, “I have always felt safe with them, I can always raise concerns if I need to.” However we found people who used the service were not always protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Not all staff had received training or guidance about the safeguarding of vulnerable adults and we found the provider did not adhere to their own policy. We have asked the provider to tell us what action they will be taking to ensure they meet the requirement of the law in relation to safeguarding vulnerable adults.

The provider did not ensure all appropriate recruitment checks were undertaken before staff could start working with people. We will consider our enforcement procedure and give the provider timescales to achieve compliance with the legal requirements in relation to requirements relating to workers.

Is the service effective?

The provider was not able to provide evidence of an effective induction process for newly recruited staff and we saw newly recruited staff had not received training. This meant people were at risk of receiving support for staff who were not appropriately skilled for the role. One to one supervision sessions for staff were not taking place and staff had not received appraisals. This meant we could not be assured that people were being cared for by staff who were supported in their role, and people might be at risk of receiving inappropriate or unsafe care. We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by the law in relation to supporting workers.

Is the service caring?

People we spoke with told us they were supported by kind and caring staff. They told us staff respected their privacy and dignity. They told us the staff listened to them and the agency were supportive.

Is the service responsive?

People and staff we spoke with were confident to raise any concerns they might have. They told us they were confident the agency would listen and would take action to address any concern, promptly. One person told us how they had raised a concern and this had been addressed promptly.

Is the service well led?

The agency had some systems in place to monitor and assess the quality of the service however these were not effective. For example, whilst the provider had policies in place to guide them and staff these were not followed. Feedback from people who used the service was sought but the provider did not analyse this or take action to identify concerns and act upon these. Incident records were in place, however we found that when incidents were reported there was no further information about action taken or learning from these. We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by the law in relation to the monitoring and assessing of the quality of the service they provide.

Inspection carried out on 14 November 2013

During an inspection in response to concerns

We inspected this agency as we had information of concern which indicated that staffing levels may not be sufficient to meet people’s needs. At the time of our visit we were told the agency was providing personal care to 18 people.

We spent time shadowing a member of staff and visited the home of two people. We reviewed the care records of four people and reviewed the duty rota’s over a 5 week period.

We found that the agency had sufficient numbers of staff to meet people’s needs and were actively recruiting for more staff to ensure that when staffing difficulties occurred they could manage this effectively to reduce the impact to people.

Inspection carried out on 9 October 2013

During a routine inspection

At the time of our visit we were told that the service provides personal care support to 20 people. There were five staff and the manager working in the service. We spoke with the manager and two staff members.

We were not able to speak with people directly and therefore requested feedback from their relatives. We spoke with four relatives of people who used the service and they provided positive feedback. One person told us “They are brilliant”; “They are always respectful and try to help (them) be as independent as possible”. Another told us “The carers (staff) are excellent. We always have the same person; they know exactly what they are doing”.

We found that the service asked for people’s consent before providing support; however they did not have appropriate systems in place to ensure that where people lacked the capacity to make a decision the Mental Capacity Act was adhered to.

We found that the provider had effective systems in place to ensure that medicines were managed effectively.

Following our visit to the service we received information of concern relating to staffing and the support provided to them. We saw that the service had enough skilled, qualified and experienced staff that were supported appropriately to meet people’s needs.

The provider had effective systems in place to monitor and assess the quality of the service they provide. People were asked for their views and these were acted upon.

Inspection carried out on 26 March 2013

During a routine inspection

We were not able to speak to people using the service because they were not available during our inspection. We gathered evidence of people’s experiences of the service by speaking to a staff member, the manager of the service, and by reviewing care records and policies and procedures.

We found that people had care plans and risk assessments in place which were based on people’s individual needs.

Staff files we looked at showed checks were undertaken before staff began work. There were instances where the provider had been unable to obtain references but had put in appropriate measures to supervise, monitor and assess staff before they worked alone.

Staff who we spoke understood about safeguarding issues and what actions to take. During our inspection we saw that the manager responded appropriately to a safeguarding concern which arose.

Peoples safety and their health and welfare was not be met by staff whose competence was demonstrated through appropriate supervision and appraisal.

Annual surveys were undertaken in order to seek the views of people using the service and their relatives.

Inspection carried out on 22 September 2011

During an inspection to make sure that the improvements required had been made

People told us they were happy with the service provided by Prados Home Help Services. They told us they believed staff recruited had the relevant skills and knowledge to provide the care and support they need. They told us that staff are friendly.

They confirmed that records about their care needs were kept at their private home’s and care staff kept these records up to date and accurate.

Inspection carried out on 28 April 2011

During an inspection in response to concerns

People told us they were happy with the service provided by Prados Home Help Services. They told us they felt safe because staff that attended to them knew what they were doing and treated them with respect. They told us they believed staff had the relevant skills and knowledge to provide their care and support.

People using the service told us they knew what to do if they hade any concerns or complaints about the service. They were confident the registered person would respond promptly and appropriately to any concerns or complaints.

They confirmed that records about their care needs were kept at their private home’s and care staff kept these records up to date and accurate.