Archived: Roche Caring Solutions

At the last inspection in October 2017 we rated the service as Requires improvement. At that inspection we found the provider was in breach of Regulation 12, Safe care and treatment and Regulation 17, Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the registered person did not have systems for the proper and safe management of medicines and systems in place to manage, monitor and improve the quality of the service provided were not always effective.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-led to at least good. During this inspection we found improvements had been made. Systems for managing medicines safely were now effective. Records of people’s medicines were accurate and well maintained. Also, the provider had introduced systems that were effective in assessing and monitoring the quality of the service provided. Staff and people were confident that issues would be addressed and any concerns they had would be listened to and acted upon.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. There were 66 people using the service at the time of the inspection.

There was a registered manager in post. 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 with staff and the care they were provided with. They said they received a good standard of care. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns. Care plans contained risk assessments which gave instructions to staff as to how to mitigate risks; these enabled and empowered people to live as independent a life as possible safely.

There were enough staff to support people safely. Staff understood their role and responsibilities for maintaining good standards of cleanliness and hygiene. The recruitment practice protected people from being cared for by staff that were unsuitable to work in their home.

Training records showed staff had completed a range of training and staff spoke highly of the training they received. Staff told us they received support, supervision and appraisal to help them understand how to deliver good care and records we looked at confirmed this.

People were supported to have maximum 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. The registered manager and staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). Staff understood their responsibilities to seek people's consent prior to care and support being provided.

People's health and well-being was monitored by staff and they were supported to access health professionals when they needed to. Where needed, people who used the service received support from staff to ensure their nutritional needs were met. Staff were trained to respond to emergencies and said they felt confident to do so. There were systems in place to make sure there was learning from any accidents and incidents.

People received care from staff that were friendly, kind and caring. People told us they were treated very well. Staff showed a good knowledge of the people they supported and understood how to maintain people’s privacy and dignity.

People had care plans that were personalised to their individual needs and wishes. Records contained detailed information to assist staff to provide care and support in an individualised manner. Peoples care and support needs were reviewed regularly

People, staff and relatives spoke positively about the management team who were visible and approachable, receptive to ideas and committed to providing a high standard of care.

Roche Caring Solutions provides both long term and short term personal care to people in their own homes within the Wakefield, Kirklees and Leeds areas.

There was a registered manager in post. 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.

Robust records were not in place to assure us of the proper and safe management of medicines. Records of people’s medications were not accurate, complete or up to date and it was not therefore possible to see if people had received their medications as prescribed. People’s care plans did not contain accurate and complete records regarding the support they needed or received with medicines. This put people’s health at risk. Medication audits had not identified the concerns found during our inspection and had not been used to drive improvements in the service. The arrangements for governance had not been effective to rectify the breaches found at our previous inspection of the service.

People told us they felt safe being supported by Roche Caring Solutions. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding adults. Recruitment was managed safely. Overall, we saw risks were managed, and staff understood how to ensure these risks were minimised.

There were enough staff employed to provide support and ensure that people’s needs were met. Staff received appropriate supervision, appraisal and training to enable them to carry out their role. Staff spoke highly of the support and training they received.

Staff knew to offer people choice and what to do in the event they refused care. The registered manager and staff we spoke with had an understanding of the principles and their responsibilities in accordance with the Mental Capacity Act (MCA) 2005.

Where needed, people who used the service received support from staff to ensure their nutritional and health needs were met. Staff were trained to respond to emergencies and said they felt confident to do so.

People told us staff were well trained, caring and kind. Staff showed a good knowledge of the people they supported and understood how to maintain people’s privacy and dignity. It was clear staff had developed positive relationships with people.

People who used the service and their relatives were involved in planning the care and support received. Care plans contained sufficient information for staff to follow and provide the care people wanted. Regular reviews had taken place to make sure people’s current needs were responded to.

There were effective systems in place for responding to people’s concerns and complaints. People told us they knew how to raise concerns if they had any.

There were systems in place to monitor and improve the quality of the service provided. However, our concerns regarding the management of people’s medicines had not been identified through the audits in place. We therefore concluded these audits on medication were not effective.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

The service is registered to provide personal care to people living in their own homes. At the time of the inspection 76 were supported by the service.

The service had a registered 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 2008 and associated Regulations about how the service is run.

Systems in place for the management of medicines so people received their medicines safely were not robust enough. This meant people were at risk of not receiving their medicines as prescribed.

There were risk assessments in place for people who used the service. Risk assessments covered areas such as mobility, medications and pressure area care. The risk assessments did not always contain enough information for staff to provide safe and effective support for people.

Staff told us the registered manager was supportive. Staff had not received supervision and appraisal at the frequency described by the registered manager.

Not all staff training was up to date and staff members had not always been assessed as competent to complete some of the more complex tasks they were asked to perform for people.

The registered manager told us staff had been on trained in the Mental Capacity Act (MCA) 2005. However, staff did not always understand what MCA was. Staff did understand the principles of supporting people well by offering choice and seeking consent when supporting people. Records we saw did not contain MCA assessments or best interest decisions where required for people who lacked capacity.

The systems in place to monitor and improve the quality of the service provided were not robust. Staff told us the service had an open, inclusive and positive culture.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident staff would respond and take action to support them. Records in relation to complaints received did not evidence the registered providers policy had been followed.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice.

There were enough staff employed to provide support and ensure people’s needs were met. We saw a very small number of missed calls had occurred. People gave us feedback that staff had been late on some occasions and they received support at times from an inconsistent staff team. The registered manager had worked hard to address these issues and continued to do so.

Effective recruitment and selection procedures were in place and we saw appropriate checks had been undertaken.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. Care records did not always reflect the current needs of people. A programme to update care records had started.

People and their families told us staff treated people with dignity and respect.

People were provided with their choice of food and drinks which helped to ensure their nutritional needs were met. Staff at the service worked with other healthcare professionals to support people with their needs.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.

People we spoke with who used the service and their relatives were complimentary about the service they received overall. One relative told us, 'I am really impressed overall by the service; they're all very friendly and very kind to my husband.' Another person said of the staff, 'They're brilliant; the care provided is also brilliant, I wouldn't want to change to anyone else.'

Staff we spoke with showed a good understanding of person centred care and the importance of maintaining people's dignity and respect. One member of staff said us, 'We always treat people like we would like one of our family to be treated.'

We saw evidence that the service had good systems in place for monitoring that staff were complying with the infection control policies and procedures.

Appropriate checks were undertaken before staff began work to make sure that they had the relevant experience and skills for the role.

The service had systems and policies in place for monitoring the quality of the service provided. There were records of monitoring that had been undertaken which confirmed an audit programme was in place.