Archived: Quality Care Team Limited

This unannounced inspection took place on 19 and 24 August 2016. There were 24 people receiving care at that time.

Our last inspection took place on 22 July 2015. The overall rating was requires improvement, with improvements needed to be made to the risk assessment process, the management of medicines and the management of people’s money. In addition, where people did not have the mental capacity to make decisions, processes were not in place to protect people from unlawful restriction and unlawful decision making. This was a breach of Regulation 11. During our inspection on 19 and 24 August 2016, we saw the necessary improvements had been made.

The service had a registered manager in place. 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.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were well trained, and well supported, by the registered manager. There were sufficient staff to meet people’s assessed needs. Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People received their prescribed medicines appropriately. People’s health, care and nutritional needs were effectively met.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making. Staff respected people choices and staff were aware of the key legal requirements of the MCA and DoLS.

People received care and support from staff who were kind, caring and respectful to the people they were caring for. People and their relatives had opportunities to comment on the service provided and people were involved in every day decisions about their care.

Care records were detailed and care plans provided staff with sufficient guidance to provide consistent care to each person. Changes to people’s care was kept under review to ensure the change was effective.

The service was well run and the registered manager was approachable. People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. People’s views were listened to and acted on. People were aware of how to make a complaint should the need arise and were confident their concerns would be taken seriously.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

During our inspection we visited five people who received a service, spoke with four of them and four relatives. We also spoke with five staff who work for the agency and two health care professionals.

Is the service safe?

People, and their relatives, all made positive comments about the service they received. They said they felt safe with the care workers and trusted them.

During our inspection we found there were effective systems in place to reduce the risk and spread of infection. This included staff training and the availability of suitable protective clothing.

However, the provider did not have effective recruitment procedures in place. We found they were not carrying out all of the relevant checks required by the regulations, before they employed new staff.

We found that risk assessments had generally been completed to assess and reduce the risks whilst care was provided. However, we found during our visit to the agency office that no risk assessments had been carried out prior to one person's care being provided. This meant that the risks associated with providing care to this person had not been assessed and the care may not have been provided safely. We noted that when we visited the person in their home a few days later, risk assessments were in place.

Is the service effective?

Although we found one person's care plan had not been updated to reflect changes in their mobility needs, we found that the care worker providing care was fully aware of the person's needs. In general, care plans provided a good level of detail so that staff knew how to provide people's care to meet their needs and preferences.

People and their relatives told us that the care met their needs. We also spoke with two health care professionals, who had regular contact with people receiving care from this service. Both were complimentary of the care provided. One said that the agency had, 'Really pulled out all the stops' to meet one person's needs. Both professionals told us the agency worked hard to resolve issues quickly and in the best interest of the person receiving the service.

Is the service caring?

During our visits to people's homes we found that staff interactions were respectful and caring in their approach. People told us this was usually the case. One person told us they were, 'Well pleased. [The care workers are] very efficient. They are helpful and kind.' Another person told us, 'They live up to their name. They're obliging, pleasant and kind. They co-operate with me.'

Staff said they consulted with the person they were assisting, and where appropriate with their relatives. They said they and listened to their views on how they would like the care to be provided and acted on these.

Is the service responsive?

Everyone we spoke to told us they were satisfied with the level of care provided and that where there had been concerns, these had been addressed by the manager. People commented on how flexible the service was. Two people told us that care workers had stayed longer than arranged when they were unwell. Two other people's relatives told us how the agency had arranged additional visits at short notice when they requested this.

People told us they had a core team of care workers who provided their care. However, two people's relatives told us this core team had taken a while to develop and they felt they had had a lot of different care workers when the service had first started.

Is the service well led?

A registered manager was in post at this service, and had been for many years. Staff told us the manager was supported and was available when they contacted them.

People who used the service, their representatives, and staff, were asked for their views about the care provided and these were acted on. All of the people we spoke with told us that they felt able to raise any concerns they had with the manager and were confident they would be addressed.

During our inspection we saw there were some systems in place to monitor the quality of the service provided to people. For example, the provider asked people to compete annual feedback forms, and we saw that action was taken in respect of their comments.

We saw that regular audits of medicine administration took place. However, there was no evidence to show that arrangement were in place to monitor other key areas of the service systematically. For example, we could see that care records were reviewed, but there was no plan in place to show when these would all be addressed. In addition, two of the records we looked at did not contain all the required information or were not up to date although they had been reviewed. In addition, there were no systems in place to monitor staff recruitment processes or ensure notifications were sent to the Care Quality Commission (CQC) or other regulatory bodies.

All the people we spoke with told us that staff understood their, or their family member's, care and support needs and were polite and attentive. During our inspection we observed staff speaking with people with respect.

Overall, people's care records we looked at were person centred and provided staff with guidance about how to meet their individual care and support needs effectively and safely. However, some people's records we looked at showed that their care plans had not been updated following a change to their care and support needs.

Staff told us that they received good training and support that enabled them to carry out their roles effectively and felt well supported by the agency. Staffs' competency to do their job was checked regularly as part of a quality assurance system.

People felt confident that they could raise any concerns with the agency and that these would be taken seriously. There were systems in place to seek people's feedback about the quality of the service they received.

People that we spoke with were complimentary and satisfied with the care and support they received from the agency. One person commented 'I am very happy with my carers and they are kind and gentle with me.'

Care and support was well coordinated but improvements to reviewing care and support and describing any changes to the care to be provided were needed. There was evidence of people's agreement and involvement in the planning of their care and support.

Staff were trained in safeguarding people from harm. Information regarding how to contact the local authority safeguarding team had been made readily available to staff and people using the agency.

The agency had an effective system to regularly assess and monitor the quality of the service that was provided to people.