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Practical Care Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 12 July 2018

This inspection took place at the Practical Care office on 12 and 13 March 2018. Following the inspection on the 14 March 2018 we made telephone calls to people and relatives who used the service. On the 26 March 2018 we made further calls to staff members to gain their feedback on the service.

At the time of the inspection Practical Care provided domiciliary care and support for 89 people in their own home. The service worked primarily with older people living with dementia and people with physical and mental health needs. People received varying levels of support depending upon their care needs from 24-hour care to one visit per day.

The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At our last inspection on 29 September 2015 we completed a focused inspection that looked at the key question of ‘effective’ only. This was to ensure that a breach of regulation found at the previous comprehensive inspection on 22 December 2014 regarding documenting people’s ability to consent to their care had been addressed. We found that the service had addressed the breach of regulation and the key question of effective was rated as ‘good’. This meant that the service was rated ‘good’ in all key questions and therefore ‘good’ overall.

At this inspection we found a breach in regulation around adequate risk assessments. The service is now rated ‘requires improvement’. This is the first time the service has been rated as ‘requires improvement’.

There was a registered manager in post. A registered manger 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 law; as does the provider. The registered manager was present throughout the inspection.

Risk assessments were inconsistent and did not always detail known risks. There was insufficient guidance for staff on how to minimise known risks to people receiving care.

Medicines were overall well managed but we have made a recommendation about medicines management.

People’s care plans detailed tasks to be completed at each care visit. However, care plans were not always person centred. The provider was in the process of updating the care plan format.

Staff understood what safeguarding was and were aware of how to report any concerns if they had them. Staff understood what whistleblowing was and who to contact if necessary.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff had received training in infection control and were aware of how to control and prevent infection.

Staff received regular, effective supervision, appraisal and training.

People and relatives were positive about staff and felt that they were kind and caring. People received a continuity of care and often had the same staff.

The service worked well with people at the end of their lives and provided end of life care. Staff were compassionate regarding caring for people at the end of their lives.

Audits were carried out across the service on a regular basis that assessed areas such as medicines management, health and safety and the quality of care. Telephone surveys were completed with people who use the service and their relatives. Where issues or concerns were identified, the manager used this as an opportunity for change to improve care for people.

Inspection areas

Safe

Requires improvement

Updated 12 July 2018

The service was not always safe. Risk assessments were not always in place for identified risks. Where risk assessments were in place these did not provide adequate guidance for staff on how to minimise the known risk.

People were receiving their medicines. However, there were no ‘as needed’ medicines protocols in place. We have made a recommendation regarding medicines.

The provider followed safe staff recruitment practices.

Staff were able to tell us how they could recognise abuse and knew how to report it appropriately.

People received a continuity of care and usually had the same staff visiting them. Staff were on time and stayed for the full duration of the scheduled care visit.

Effective

Good

Updated 12 July 2018

The service was effective. Staff had on-going training to effectively carry out their role.

Staff were aware of the Mental Capacity Act 2005 (MCA) and how this impacted on people that they worked with.

Staff received regular supervision and appraisals. People were supported by staff who regularly reviewed their working practices.

People were supported to have enough to eat and drink so that their dietary needs were met.

People were promptly referred to healthcare professionals in a timely manner.

Caring

Good

Updated 12 July 2018

The service was caring. People were supported and staff knew people well and understood individual’s needs.

People were treated with respect and staff maintained privacy and dignity.

People were encouraged to have input into their care and were involved in planning their care.

People were encouraged to be as independent as possible.

Responsive

Good

Updated 12 July 2018

The service was responsive. People's care plan detailed tasks to be completed. However, people’s personal histories, likes and dislikes had not always been noted. The service was updating care plans.

Staff were knowledgeable about individual support needs, their interests and preferences.

People were encouraged to be independent, be part of the community and maintain relationships.

People knew how to make a complaint. There was an appropriate complaints procedure in place.

End of life care was well managed.

Well-led

Requires improvement

Updated 12 July 2018

The service was not always well led. Whilst risk assessments had been completed the registered manager had not audited them to ensure that they provided staff with enough information to mitigate known risks.

Medicines audits had failed to pick up issues identified during the inspection.

There were regular staff meetings that allowed the sharing of information and ideas.

There was good staff morale and guidance from the registered manager and senior staff members.

The service had a positive open culture that encouraged learning. Staff felt supported by management to carry out their role effectively.

Systems were in place to ensure the quality of the service people received was assessed and monitored.