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Inspection report

Date of Inspection: 23 January 2012
Date of Publication: 28 February 2012
Inspection Report published 28 February 2012 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

People receive care and support which is personalised to their assessed needs but are not always provided with copies of written care plans. There are insufficient systems in place to assess and manage possible risks for people’s regarding environment and medications.

User experience

The Service User Guide informed people that a care plan would be drawn up and reviewed if their needs changed. People were encouraged to let the agency know if there were any changes to their needs.

One person told us they had records in their home which staff recorded in each day. We spoke to a relative of a person who received care; they told us that the care plan was up to date and that they had also received a copy as well as the person who received care.

Where people’s needs had changed one person told us that they now received more support than they initially did when they began using the service.

Other evidence

We looked at the care plans for two people using the service. These contained up to date and clear information about peoples assessed needs.

The level of detail in the care plans was good in describing the preferences people had and their daily routines. One care plan described how the complex needs of the person were to be met in detailed step by step instructions for staff. The care plan considered and addressed and took into consideration any known risk factors.

The care plans we looked at recorded and considered peoples’ healthcare needs. One staff member told us that they called the doctor or district nurse for people if people asked them to.

Five of the people using the service were supported solely with assistance to take medicines. Care plans were in place specifically for this to inform staff about the help required. Medication administration records were completed to record which medications had been given. The agency was not however completing medication risk assessments to establish areas of potential risk and needs.

We observed that as part of the initial visits some environmental risk assessments had been completed these were specific to the persons home but there was not a holistic risk assessment format in place to consider the environment as a workplace for staff. The independent quality review of the service also identified that for people living in the on site apartments there were no environmental risk assessments completed and the action plan had not been updated to state this had been done.

Moving and handling risk assessments also recorded how to safely help people to move. There was a system in place to review care plans periodically or when needs changed.

Staff completed a written record for each visit they did. We found these were consistently being written and gave sufficient detail about the care being given.

The manager told us that some care plans were not held in peoples’ homes. Where people lived in the onsite apartments the care records were held in the agencies office so people did not have access to them. This is identified as an action to improve on the independent quality review of the service but this has not yet been completed. The Service User Guide did inform people that they had a right to look at the personal information held by the agency and the manager told us they would address this.