Background to this inspection
Updated
16 March 2017
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.
This comprehensive inspection took place on the 15 and 17 February 2017 and was announced.
This inspection was carried out by one inspector.
Prior to our inspection we reviewed the information we held about the service, this included the provider’s action plan following our inspection carried out in January 2016 and October 2016 where they told us what they would do to ensure compliance with the law. We spoke with the local authority and reviewed all other information provided to us from stakeholders.
We visited three of the 15 people currently using the service and spoke with one person on the telephone. We spoke with one person’s relative about their observations on the care their relatives received. We spent time talking with the provider, the manager, the deputy manager and three care staff.
We looked at records in relation to four people’s care. We looked at the provider’s policies and procedures, care records and records relating to the management of people’s finances, medicines, staff recruitment, staff training and systems for monitoring the quality and safety of the service.
Updated
16 March 2017
This inspection took place on the 15 & 17 February 2017 was announced. The provider was given 24 hours’ notice because the location provides a domiciliary care service and the provider is often out during the day providing care; we needed to be sure that someone would be in.
At the last two inspections, the service was rated Requires Improvement. At this inspection we found the service remained Requires Improvement.
About Care is a domiciliary care service providing personal care to people in their own home. On the two days of our inspection there were 15 people using the service.
At our last two inspections in January 2016 and October 2016 we identified continued breaches of regulatory requirements in relation to the lack of safe and effective systems in place regarding the recruitment and selection of staff, the lack of policies and procedural guidance to guide staff in steps they should take to protect people from the risk of harm. This meant that the health, safety and welfare of people using the service was at risk and the provider was failing to provide a safe service.
We formally notified the provider of our escalating and significant concerns following our inspection in October 2016 and shared this information with our stakeholders. We placed a number of conditions on the provider’s registration which required them to take action to protect people from the risk of harm. Whilst the provider has taken action to meet the majority of the conditions placed on their registration, they failed to submit monthly quality and safety audit reports as required.
At this inspection 15 and 17 February 2017 we found some improvements had been made. The provider was working with the local authority as part of the commissioner’s contract management plan. An action plan was in place to address the improvements required to protect the health, welfare and safety of people who used the service. This included addressing shortfalls in areas such as care records, risk management and care worker recruitment.
Although the manager provided staff with training in understanding their roles and responsibilities with regards to the Mental Capacity Act 2005 it was evident they did not fully understand their roles and responsibilities in meeting the requirements of the law.
With the support and guidance provided by the local authority, provider support team, care plans including risks assessments had been updated as required to reflect people’s changing needs and now provided staff with the guidance they needed to mitigate the risks to people’s safety.
The provider had updated their policies and staff had been provided with updated procedural guidance in managing risks to people’s health, welfare and safety including how to manage people’s medicines and financial transactions appropriately. However, further work was required to ensure planning dates for future reviews of their policies as required. This meant that there was no system in place to ensure continuous review to make sure policies and procedural guidance for staff were fit for purpose, reflecting changes in legislation and current guidance.
Previously the manager spent 50% of their time providing care in the community. Since our last inspection a deputy manager had been appointed. This enabled the manager to have more capacity to focus on the day to day management of the service and maintain management oversight of the service.
The provider is also registered as the manager of the service but is no longer in day to day management of the service. The provider had appointed a manager who had been in post two and half years. They were currently in the process of applying to register with the Care Quality Commission (CQC) and about to attend their fit person’s interview. 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.
All of the staff and people who used the service were complimentary regarding the manager and the service they received. People’s views regarding the quality of the service had been surveyed and they told us they did not have any complaints. Where people had previously expressed concerns to the manager, they told us prompt action had been taken and issues resolved to their satisfaction.
During this inspection we identified breaches 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.