11 and 12 December 2014
During a routine inspection
The inspection took place on 11 and 12 December 2014, and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection. At the last inspection on 17 December 2013 we found the service met five of the outcomes inspected, but was in breach of Regulation 20, outcome 21, records. The provider had taken action and at the time of this inspection, there were no breaches of the legal requirements.
The provider, registered manager, and senior staff assisted with the inspection. They worked as a team to make sure we had the information we requested. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
The 121 Care and Mobility service is registered to provide personal care to people, living in their own homes in the community. People received support in line with their assessed personal care needs. The service was providing care to 212 people whose support hours varied from one to four calls a day, with some people requiring two members of staff at each call.
At the inspection on 17 December 2013 we found that the service was in breach of Regulation 20, Outcome 21, records. The provider was now compliant with this regulation as records had improved and there were systems in place to check that records were being completed appropriately.
People told us they felt safe when staff were supporting them with their care. Staff had received training in how to keep people safe and demonstrated a good understanding of what constituted abuse and how to report any concerns.
Systems were in place to manage risks to people and staff. In some cases further information was required so that staff had detailed written guidance to support people. For example, guidance about how to move people consistently and safely.
There were sufficient numbers of staff on duty to make sure people needs were met. Staff had permanent regular schedules so that people received care from a consistent staff group.
People were protected by robust recruitment procedures and new staff had induction training, which included shadowing experienced staff, until they were competent to work on their own.
The service had recently reviewed the medicine procedures and was in the process of introducing a new system to monitor and check staff practice and improve the recording of the medicines by staff. We have recommended that the service reviews their medicines policy and procedures in line with current guidance.
People told us they were very happy with the service being provided. Staff knew people’s individual needs and how to meet them. Staff received core training and specialist training, so they had the skills and knowledge to meet people’s needs. They fully understood their roles and responsibilities as well as the values of the service.
People were able to make decisions about their care and support. Staff were up to date with current guidance to support people to make decisions. The staff had received training on the Mental Capacity Act 2005. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. The registered manager told us that at this time people had the capacity to make their own decisions; therefore no best interest meetings had been required.
People were supported with their nutritional and health care needs. The service made appropriate referrals and worked jointly with health care professionals, such as community nurses, to ensure that people received the support they needed.
Staff were caring and treated people with dignity and respect. People said that the staff were kind and polite. People told us that the staff arrived on time and stayed the duration of their call.
People were involved in the assessment and the planning of their care. The amount of details in the care plans varied and information was recorded in the daily notes, but this was not always reflected in the care plans. People were confident that staff provided personalised care and knew their routines well. The registered manager told us that they would review the format of the care plans to improve all the relevant details.
People told us that their care plans had been reviewed when senior staff visited them and any relevant changes were made when required. Staff said the communication between the staff and the office made sure that they were up to date with people’s changing needs.
People and staff were supported by an out of hours on call system. Staff told us that this was always responsive and any queries raised were sorted out promptly.
People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided both informally and formally. Feedback received had been positive.
The culture within the service was personalised and open. There was a clear management structure in place and staff told us they were all part of the team. They said they felt comfortable talking to the managers about their concerns and ideas for improvements. There were systems in place to monitor the safety and quality of the service being provided. The service looked at new ways of working to continuously improve the service.