Archived: Verina Daly Care

We carried out an inspection on 30 September 2014 to follow up on the progress the service had made in the areas of consent to care and treatment and supporting workers.

During the inspection we spoke with the provider, who is also the manager and also spoke with the new administrator. We spoke to one relative, two members of care staff and received email comments from a third member of staff. At the time of our inspection there were nine people who used the service and 19 care staff. We also received information from another healthcare professional who was involved with the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

This is a summary of what we found-

Is the service safe?

The service was safe because staff were trained and felt competent. One told us

'An example is catheter training that I recently received from my senior carer.'

Is the service caring?

People told us this was a caring service. A relative said the staff were 'Very, very caring. More so than I would have expected.' A member of staff told us, 'I have previously worked for a different care agency and the difference in the other care staff and their knowledge here is great. Everyone I have met from this service seem to be genuinely caring people.' Another member of staff said 'I've never seen people cared for to such a standard.'

Is the service responsive?

The providers had responded to the concerns we raised and implemented significant changes to the way they supported and trained staff.

Is the service effective?

The service was effective because the provider had implemented the necessary changes to the procedures for staff support and training. This included in the area of consent to care and treatment.

Is the service well-led?

Staff told us they had confidence in the manager. They said the recent changes in management style meant things were running more efficiently. When we asked a relative if they felt it was a well led agency, they said 'It's all fine.'

This inspection was carried out by a single inspector. We carried out an inspection on 29 July 2014 to follow up on the progress the service had made since our last inspection. At the last inspection, on 1 April 2014 we found serious concerns in relation to care and welfare of people, recruitment procedures, quality monitoring and the record keeping. We served four warning notices on the provider in relation to these concerns. During this inspection we found the provider had made significant improvements and was compliant with all the warning notices. Further improvements were needed to ensure full compliance and the provider had a plan in place to achieve this.

During the inspection we spoke with the administrator and the registered provider, who is also the day to day manager of the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

This is a summary of what we found-

Is the service safe?

The provider had made improvements to their recruitment procedures which protected people from the risk of being cared for by unsuitable workers. They had also made improvements to their care planning documentation, which was much more detailed and provided staff with the information they needed to deliver safe and appropriate care.

Is the service caring?

The care planning documents were written in a way that respected people's dignity and reflected their individual needs and choices. Care staff wrote detailed daily records in which they commented on people's moods and wellbeing. This showed staff cared about people and passed on information to other care staff so they could provide consistent care.

Is the service responsive?

Care planning and delivery was responsive because care plans reflected people's changing needs and were regularly reviewed. There was evidence that people were consulted about their care as were their relatives if appropriate.

Is the service effective?

The service was effective because people were involved in their care planning and their individual needs were recorded in their care plans. We saw examples of how people's individual needs were met. For example, we saw records were kept of one person's food and fluid intake and where the fluid intake was low this was highlighted in the daily notes so the next member of staff was aware and could encourage fluids.

Is the service well-led?

The manager had made the improvements we asked for at our last inspection. They were open and transparent about the progress they had made and what was still needed. There were new systems in place to monitor the quality of the service, such as staff questionnaires and regular auditing of records.

During the inspection we visited the registered office location and spoke to a member of staff who told us they were the administrator. The provider joined us in the office at lunch time. On the same day we spoke with two care staff and visited the homes of three people who used the service. One of these people lived in a property adjoining the registered office location. There were seven people receiving a service at the time of our inspection.

Following the inspection visit, we spoke on the telephone to six members of care staff. We also had telephone conversations with one person who used the service, one relative and one close friend of someone who used the service (with the permission of the person who used the service). We also had discussions with the provider and administrator.

We also had telephone conversations with a pharmacy inspector, a registered nurse and Hampshire County Council Safeguarding Authority.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service well led?

Is the service responsive?

This is a summary of what we found:

Is the service safe?

People were not protected from unsafe care and treatment because the records relating to the planning and delivery of their care was disorganised, inaccurate and not kept up to date. There were no risk assessments in place to ensure people were provided with safe care and treatment.

The provider's recruitment procedures did not protect people from being cared for by unsuitable workers. The recruitment records we looked at for nine of the 18 staff employed by the agency were disorganised and varied in the quality and quantity of what they contained. The provider had undertaken a suitable criminal record check for only four of the nine staff whose files we looked at.

Our findings also showed that people were at risk because staff had little or no understanding about whether or not people were consenting to the care they received. Staff had not received any training on The Mental Capacity Act and said things like, 'What sorry, never even heard of that', and, 'No I don't think I have.'

Is the service effective?

People told us they received the care they needed, however the lack of formal processes for reviewing care, training staff and consulting people meant the service overall was not effective. During this inspection we looked at six outcomes. We found the provider was non-compliant with all six. The provider had failed to regularly assess and monitor the quality of the service being provided and this resulted in people not being protected against the risks of inappropriate or unsafe care and treatment.

Is the service caring?

People told they were happy with the service they received and had no concerns or complaints. Staff mostly told us they enjoyed their work and felt people were well cared for. They said they felt well supported.

Is the service well-led?

People told us the provider for this service was very approachable. Staff told us they received adequate support from them. However, the provider did not have any formal staff supervision and appraisal systems in place to monitor the competency of her staff. Staff were not always trained in the areas they needed to be and this left people at risk of receiving unsafe care and treatment.

There were no systems in place to monitor the quality of the service. This meant that all six of the outcome areas we assessed were non-compliant.

We found that the quality and accuracy of the records held about were of a poor standard. For example, of the three sets of care records we looked at we found that all of them lacked the detail needed to provide safe care and treatment.

Is the service responsive?

Care planning and delivery was not responsive because care plans were brief, inaccurate and not kept up to date. There was no evidence that people were consulted about their care and whether the service responded to people's needs and wishes.