21 September 2017
During a routine inspection
The service is a domiciliary care agency which provides personal care to people in their own homes. People received support through scheduled visits. At the time of our inspection there were 53 people using the service.
At our previous inspection in May 2016 we found breaches of the regulations in relation to the arrangements in place to ensure people received their medicines safely, how the provider supported its staff through training and appraisal and the systems in place to assess and monitor the quality of care people received. The overall rating for the service was, "requires improvement." We asked the provider to tell us how and when they would make the required improvements. Some of these actions have been completed. However the provider had not made improvements to the systems in place to assess and monitor the quality of care people received.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Registered providers must notify the CQC about certain changes, events and incidents that affect their service or the people who use it. The provider did not notify CQC of notifiable events such as allegations of abuse. This meant the CQC did not have full oversight of the risks associated with the service.
People told us that staff were regularly late and did not stay for the time allotted. People also told us they had experienced missed visits. This meant that care was not always delivered in accordance with people's care plans.
Staff knew how to recognise abuse and report any concerns. Risk assessments were carried out to evaluate any risks to the person using the service. Where risks were identified, risk management plans were in place for staff to follow.
People told us the staff were caring and treated them with respect. People were involved in planning their care and were asked for their consent before care was provided. Staff understood the main principles of the Mental Capacity Act 2005 and how it applied to people in their care.
People were supported to have a sufficient amount to eat and drink which minimised the risk of malnutrition and dehydration. Staff liaised well with external healthcare providers which assisted people to maintain their health. People told us they received their medicines as prescribed.
The provider did not have an effective system in place to receive, respond to and learn from complaints from people or their advocates. The system in place did not allow for complaints made over the telephone to be recorded, investigated and responded to.
Staff were recruited using an effective procedure which was consistently applied. Staff were appropriately supported by the provider through training, supervision and appraisal. However, staff did not feel listened to by the provider and staff morale was low.
There were a variety of systems in place to assess and monitor the quality of care people received. However these were not always effective in identifying areas which required improvement. Where the provider was aware that an area of the service required improvement they did not always take action to make the required improvements.
We found breaches of the regulations in relation to the provider's failure to protect people from neglect, the provider's failure to notify the CQC of notifiable events and the lack of effective systems to handle complaints and to assess and monitor the quality of care people received. You can see what action we asked the provider to take at the back of the full version of this report.
Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.