26 October 2015
During a routine inspection
This inspection took place on the 26 October 2015 and was announced. The service is registered to provide personal care to people when they are unable to manage their own care. At the time of our inspection the service was providing care to 17 people in their own homes.
There was a registered manager in post at the time of our inspection. 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.
The provider had adequate recruitment systems in place; which included appropriate checks on the suitability of new staff. There was a stable staff team and there were enough staff available to meet peoples’ needs.
Staff were not always trained in all the areas they required because the induction process for new staff had mainly comprised shadowing and working alongside more experienced staff. Formal induction training had not completed in a timely way and several of the staff had not completed training in core subjects. Therefore management could not be fully assured that staff would know about best practice or recognise poor practice. The provider had a training programme in place which indicated that all the staff would have completed their induction training by December 2015. Staff supervision was a practical arrangement whereby the management worked alongside staff to provide care; there was no formal system in place to regularly review staff performance and to support their development.
Peoples’ views were sought and their consent was obtained before care was provided, although this was not always recorded in their individual plans of care. People were supported to maintain their nutrition; fluids were encouraged when people were at risk of dehydration and the provider liaised with the GP, district nursing service and dietitian accordingly. People at risk of the effects of pressure on the skin had input from the district nursing service and the appropriate equipment was provided; people at risk of falls had been referred to the falls prevention service.
People who used the service and their relatives were consistently positive about the way staff treated them. Staff interacted with people well; they were listened to and their views were acted upon. People who used the service had a sense that they mattered and that staff were concerned for their wellbeing. Peoples’ privacy and dignity was respected in all aspects of their care; staff were knowledgeable about peoples’ individual needs and they spoke in a kind and caring way, with insight into peoples’ needs and the challenges they faced.
Although peoples’ care was planned to ensure they received the support that they required to maintain their health, safety, independence, mobility and nutrition; they were supported to access appropriate health care services and had access to appropriate equipment to meet their needs. People received support that maintained their privacy and dignity and when they required staff to support them with their medicines appropriate systems were in place. However people’s care plans were not always updated and reviewed which put people at risk that they may not always reflect their current needs. This puts people at risk of receiving inconsistent care or not receiving the care and support they needed. The individual plans of care were not person centred and did not cover all of their individual needs or include details about how the care was to be provided.
Although people were able to contact the manager if they had any concerns the complaints process had not been fully implemented as there was no service users guide to inform people about all of the relevant contacts and the timescales involved for acknowledgement, response and resolution.
People and staff had confidence in the management of the service; however management systems had not been fully established; for example there were no formal systems in place to monitor and assess the quality of service provided. There were no formal arrangements in place for staff meetings or staff supervision and the management of staff training was not robust. However this was mitigated by the full involvement of the manager in the provision of care who worked alongside the staff on a daily basis. However as the service grows and develops reliance on the manager’s practical involvement may not be sustainable.
We identified a number of areas where the provider was in breach of Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end to this report the action we have asked them to take.