Background to this inspection
Updated
10 September 2016
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.
The inspection took place on the 8 August 2016. This visit was announced, which meant that the registered manager and staff knew that we were coming. We did this, as the service is a domiciliary care agency and we wanted to ensure that appropriate staff were available to talk with us, and that the person and their relative, who used the service, were made aware that we may contact them to obtain their views. The inspection team consisted of one inspector.
Before the inspection we asked the registered manager to complete a Provider Information Return (PIR). This is a form that asks the registered manager to give some key information about the service, what the service does well and improvements they planned to make. Before the inspection we checked the information that we held about the service and the service provider. We used this information to decide which areas to focus on during our inspection.
During our inspection we spoke with one relative, four members of staff, a healthcare professional, the registered manager and the area manager. Surveys had also been sent and received from staff and healthcare professionals to gain their feedback on the service. We reviewed a range of records about the person’s care and how the service was managed. These included one person’s care records, their medicine administration record (MAR) sheets, five staff training, support and employment records, quality assurance audits, incident reports and records relating to the management of the service.
The service was last inspected in November 2013 and no areas of concern were noted.
Updated
10 September 2016
The inspection took place on the 8 August 2016. This visit was announced, which meant the registered manager and staff knew that we were coming. We did this, as the service is a domiciliary care agency and we wanted to ensure that appropriate staff were available to talk with us, and that the person and their relative, who were using the service, were made aware that we may contact them to obtain their views.
Scope is a domiciliary care agency providing inclusion support to three people living in their own homes, one of which received support with their personal care needs, the service’s regulated activity. The service provides tailored support packages to adults with physical disabilities in the Brighton & Hove and East Sussex areas. The service also provides a day service for people to attend. However, not all of the support provided by the agency was looked at as part of this inspection.
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.
Regular audits were undertaken to ensure that the service the person received complied with the service’s aims and vision. However, actions resulting from the audits had not always been fully implemented. For example, an internal audit had highlighted that the storage for medicines coming in and out of the day service needed to improve. Measures had been taken to improve this issue, such as more rigorous stock control measures, however, these had not proved effective and were not implemented. The registered manager had sought advice from a healthcare professional within the organisation to further improve this and was trialling a new method of monitoring medicines being brought into the service. Due to the fact that this was yet to be fully implemented there was a risk that the person’s medicines could have been misused as there were no mechanisms in place to monitor the amount of medicines being brought in and out of the day service. This is an area of practice in need of improvement.
Records were comprehensive and detailed. However, not all records that contained information about the person’s needs were stored in a confidential way and therefore there was a risk that people’s confidentiality was not maintained. This had been recognised by the registered manager as an area of practice that required improvement, however, following their discussions with the management team, it had been decided that the storage of some information remain unchanged as this enabled the information to be easily accessible for staff. This is an area of practice in need of improvement.
The person’s safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns regarding the person’s safety. Risk assessments ensured that risks were managed and the person was able to maintain their independence. There were safe systems in place for the administration and disposal of medicines. The person’s relative told us that the person received their emergency medicines, when required and records confirmed this.
Sufficient numbers of staff ensured that the person had a dedicated and consistent team of staff to ensure their safety and meet their needs. The staff were suitably qualified, skilled and experienced to ensure that they understood the person’s needs, condition and preferences. Essential training, as well as additional training to meet the person’s specific needs, had been undertaken and used to improve the care the person received. The person’s relative told us that they felt confident in the abilities of staff. When asked if they felt that staff were well-trained and experienced, they told us “Yes, the staff are, they even went to the respite service that my relative goes to and observed how to use the hoist and sling”.
The person’s relative confirmed that consent was gained before staff offered support. Staff told us that they always involved the person in any decisions that affected them and were able to interpret the person’s response by the sounds they made and their facial expressions. The person’s relative confirmed that the person was able to communicate their feelings and thoughts to staff and that staff knew how to interpret the person’s communication and preferences well. Staff had an awareness of the legislative requirements with regards to gaining people’s consent and what to do if people lacked capacity.
The person was supported to maintain sufficient quantities of nutrition and hydration. Staff had received training to support the person appropriately and the person’s relative confirmed that they were confident in the staff’s abilities to provide appropriate support with the person’s nutritional requirements. The person had access to relevant healthcare professional and services to maintain good health. A healthcare professional told us “The Scope team meet my client’s clinical support requirements well”.
Positive relationships between the person and staff had been developed and the person was encouraged and supported to maintain relationships with others. The person’s relative and a healthcare professional were complimentary about the caring nature of staff, the relative told us “They’re all so friendly; I’ve never had a problem with any of them”. A healthcare professional further confirmed the caring nature of staff and told us “Based on my professional experience of working with Scope, and feedback from the families of my clients, the service is caring, compassionate and very responsive to the client’s needs”.
Privacy and dignity was respected and staff showed a good awareness of how to support the person in a way that maintained their dignity when they were being supported with various tasks. The person and their representatives were involved in the person’s care and any decisions that related to this. The person’s right to make a complaint was also acknowledged. The registered manager welcomed feedback and used this as opportunity to develop the service provided. The person received personalised and individualised care that was tailored to their needs and preferences. Person-centred care plans informed staff of the person’s preferences, needs and abilities and ensured that the person was treated as an individual. A healthcare professional told us “The package in place for the person is a good example of the responsiveness of Scope as a care provider. Of all the agencies I work with locally, Scope provides the care that I feel most confident to describe as person-centred”.
There was a positive culture within the service and this was demonstrated in the approach by management and staff. The person’s relative, healthcare professional and staff were complimentary about the management team. There was a strong sense of leadership from the management team and staff felt supported and valued. One member of staff told us ““Absolutely, yes, you couldn’t ask for a better team of managers. They’re very dedicated to helping the people and they always listen and give you time”. The registered manager further demonstrated a sound commitment to ensuring the aims of the service were embedded in practice. They told us “I want to ensure that people have the same opportunities as other people their age can have. They can lead and guide us as to what they enjoy and what they want to do with their time. I see the people as my focus; everything else comes second to that. We take people and help them to grow”.