12 February 2019
During a routine inspection
This was an announced, inspection which commenced on 12 February 2018. There were 40 people using the service. We gave 48 hours’ notice of this inspection to make sure that people who used the service and staff would be available to speak to us.
The service had a registered manager in post. 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.
This inspection was bought forward from the planned date due to concerns raised by the local authority regarding the care provided to people.
At the last inspection of 29 July 2016, the service was rated Good. At this inspection we found the service has deteriorated to Requires improvement.
At this inspection, we found that there was a lack of managerial oversight of the service. Effective quality assurance checks were not in place to enable the registered manager and senior staff to assess and monitor the quality of the service. The service arrangements were not robust as they had not recognised the issues we identified during our inspection. Improvements were required to ensure that all staff employed by the service received training in the Mental Capacity Act 2005.
Despite this training not being in place we found at the time of the inspection that people were supported to have maximum choice and control of their life and staff supported them in the least restrictive way possible.
Recruitment checks had been completed on all staff before they commenced working at the service. However, processes had not been recorded with regard to employing and supporting staff of the same family. Suitable arrangements were not in place to ensure that newly employed staff received suitable training opportunities, robust induction, formal supervision and an annual appraisal of their overall performance. The provision of planned staff supervision and reviewing peoples care plans had declined over the past three months. This was due to care staff leaving the service and despite attempts, the recruitment of sufficient new staff members had not been successful. The service continued to try to recruit additional staff. As a result, the senior managers of the service were frequently providing care to people at the expense of the managerial oversight of the service.
Suitable control measures were not always in place to mitigate risks to the people using the service. Risk assessments had not been developed for all areas of identified risk to people and the service had not successfully communicated with other professionals so that there were clear care plans in place.
Despite the above, people told us that they felt safe. The senior staff were providing regular care visits and people told us that there had not been any missed calls.
The medicine records were unclear as to whether people had taken their prescribed medicines. At the time of our inspection medicines audits were not being carried out but were planned for the future.
Although staff delivering care were supporting people and people told us they were well cared for, the senior staff of the service were not always acting in a way that demonstrated that they cared about the wellbeing of the people they supported. This was because they did not ensure that the service being delivered maintained people’s safety and wellbeing.
People spoke positively about the way staff treated them and reported that they received appropriate care. Staff demonstrated a good knowledge and understanding of some of the people they cared for and supported, such as people with a diagnosis of diabetes, but this information had not always been recorded and reviewed in the person’s care plan. Staff lacked knowledge in other areas of care such as how to support a person with pressure ulcers.
People told us that their personal care and support was provided in a way which maintained their privacy and dignity. However, we found that people’s care plans did not always contain relevant and current information to guide staff on the most appropriate care people required to meet their needs.
The service had a complaints process in place and people informed us that the on-call system was effective.
You can see what actions we told the provider to take at the back of the full version of the report.