This announced inspection took place on 13, 16 and 17 January 2017. Gold hill homecare is a domiciliary care agency which provided care to people in their own homes. The service had a registered manager in place. 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.
Overall we found the service to be well managed. Staff appeared to be committed to offering a good service and had confidence in the senior staff and registered manager. People received medicines from staff who had been trained. However, they did not always comply with the requirement to record what medicines they had administered to people. Despite several attempts by the registered manager to address this problem, it was still ongoing. We spoke with the nominated individual following the inspection, and measures were to be put in place to ensure this situation was improved with immediate effect.
We also had concerns that when a medicine error occurred, medical advice was not always sought for people. We have made a recommendation to the provider to improve their practice in this area.
Prior to care being provided an assessment of people’s individual needs was carried out. From this information a care plan and risk assessments were drawn up. Some people told us they were involved in reviewing their care. Documents verified this. Through talking with staff it was apparent staff were familiar with the individual needs of the people they supported.
People spoke positively about the care they received and the skills and knowledge of the staff. Where people were being cared for by regular staff it was clear that strong relationships had developed. People were pleased to have regular carers. Where visits to people may have been delayed, staff telephoned people to inform them of the situation. An on call facility was available for people and staff to call outside of office hours for support or guidance.
Prior to staff being employed the necessary checks were carried out to ensure their safety and suitability to work for the service.
People told us they believed staff were sufficiently trained to meet people’s needs. Training records showed 78% of staff were up to date with the training deemed mandatory by the provider. Staff received induction training and continuous support throughout their employment. This took the form of supervision, spot checks, competency checks, staff meetings and appraisals.
The service was complying with the Mental Capacity Act 2005 (MCA). We found mental capacity assessments had not always been completed appropriately, for example they were not time or decision specific. The registered manager implemented a new form which highlighted these areas and would improve their accuracy.
Where people required support with food and drink this was provided by staff. People were also supported to maintain good health, with staff being vigilant in noticing health changes in people and responding appropriately.
People told us staff were caring. Staff projected a caring nature when we spoke to them. Staff knew how to protect people’s privacy and dignity, and placed value in doing this. People told us staff were kind and compassionate. Staff knew the importance of supporting people to be as independent as possible. There was evidence staff had gone over and above what was expected of them in the course of their work, to support people and show kindness and sensitivity.
People told us they knew how to complain but they had never needed to. The provider had a complaints procedure in place, and records showed it was used effectively.
Both people and staff told us they felt the service was well managed. It was apparent in the records the provider had actively sought feedback from people and staff either through questionnaires, care reviews, home visits or through complaints. Actions had been taken in response to the information received to improve the service to people.
Staff felt supported and committed to provide the best quality of care they could. They were clear about the expectations of their role, and felt they performed well. As a result of positive support, staff valued the management team, and expressed high levels of job satisfaction in their roles.