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Practical Care Requires improvement

Reports


Inspection carried out on 12 March 2018

During a routine inspection

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 carried out on 29 September 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 22 December 2014 at which one breach of legal requirement was found. The registered provider had not ensured that staff were trained in the Mental Capacity Act 2005 (MCA) and there were no systems in place to record people’s consent with all care provided.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook a short notice announced focused inspection on 29 September 2015 to check that they had followed their plan and met legal requirements. We found that the provider had followed their plan and legal requirements had been met.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Practical Care on our website at www.cqc.org.uk.

Practical Care is registered to provide personal care services to people living in their own homes. The services they provide include personal care, housework, shopping and assistance with medicines.

The service had a registered manager. 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 and associated Regulations about how the service is run.

We found that staff had received training in the MCA, and understood their responsibilities under this act. Improvements had been made to the service’s care records to include people’s consent to any changes in their care provisions, or make decisions in their best interests if required.

Inspection carried out on 22 December 2014, 21 January 2015

During a routine inspection

This inspection took place on 22 December 2014 and 21 January 2015. It was unannounced.

Practical Care is registered to provide personal care services to people living in their own homes. Services are provided to people with a range of needs including physical disabilities, and mental health needs. The majority of people using the service are older people. At the time of our inspection 18 people were receiving a personal care service, and the agency employed 18 staff members. At our last inspection in April 2014 the service was meeting the regulations inspected.

The service had a registered manager. 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 and associated Regulations about how the service is run.

We found that people were kept safe and free from harm. There were enough numbers of staff employed to meet people’s needs and provide a flexible service. However staff had not received training in the Mental Capacity Act 2005, and there were no systems in place to ensure that this was followed.

In other areas staff received regular training and were knowledgeable about their roles and responsibilities, and they received regular supervision and support.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported. People spoke highly of the support staff provided.

People were supported to eat and drink, and to attend health care appointments. Safe systems were in place for staff to support people their prescribed medicines.

People told us that the registered manager was accessible and approachable, and that they felt able to speak up about any areas for improvement. There were regular checks in place to review the quality of the service provided to people.

At this inspection there was one breach of regulations in relation to obtaining consent from people. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 16 April 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions;

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 is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. There were effective recruitment and selection processes in place, and staff had been through induction and shadowing before starting work. This ensured that the staff were of good character and were competent to meet the care and welfare needs of people.

Is the service effective?

People’s health and care needs were assessed, specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in the care planning process and that they were happy with the care that was provided.

Is the service caring?

People were supported by kind and attentive staff. People told us that care workers showed patience and gave encouragement when supporting people. One person told us, “staff are very flexible and help me to do what I want.’’ People using the service, and their relatives, were contacted regularly to check if they were satisfied with their care. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. The provider had a robust complaints procedure that was accessible to people who use the service.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff told us that the manager was “always rooting” for people who used the service and “responded very quickly.”

Staff told us they were very happy with the manager, “she is good at providing support when you need it.”

Staff were clear about their roles and responsibilities, and had a good understanding of the ethos of the agency.

Inspection carried out on 23 September 2013

During a routine inspection

We spoke with four people who used the service and two relatives. They informed us that staff treated people with respect and dignity and they were satisfied with the services provided.

People who used the service had been assessed and their choices and preferences were recorded. Risk assessments had been prepared for people. Care plans were in place and the care provided was closely monitored by the manager. The manager and two care staff we spoke with were aware of the needs of people and the care to be provided. The agency had a policy and procedure for the administration of medication. Staff responsible for assisting with medication had been provided with medication training.

People who used the service indicated that their care staff were competent and reliable. Staff had been carefully recruited. The recruitment records contained the required documentation. Staff we spoke with were knowledgeable regarding their roles and responsibilities.

The agency had a complaints procedure. People and relatives knew who to talk to if they were unhappy with the services provided. There was a record of compliments received.

Inspection carried out on 1 February 2013

During a routine inspection

We spoke with one person who uses the service, and two relatives, about this agency. Everybody was happy with the quality of services provided. Comments included, “They are very good”, and “We have nothing to complain about.” Everybody told us staff from the agency treated them with respect.

People praised the staff supplied by the agency. “The staff are very good,” said one person. “They’re very helpful,” another person told us. People told us they had regular contact with the manager about their experience of the service. “The manager asks if we are happy all the time,” one person said. This meant the agency provided an individualised service that aimed to meet people’s needs.

We found, however, that a staff member started providing personal care to someone in their home a number of months before the provider had acquired recruitment checks including references and a Criminal Records Bureau disclosure. This meant the provider’s recruitment systems put people at risk receiving care from someone who may not be of good character.

Inspection carried out on 12 January 2012

During a routine inspection

We spoke to relatives and representatives of people who use services. None of the small amount of people who directly use services were in a position to easily speak for themselves.

People’s relatives confirmed that visiting staff listened to them and provided services as they wanted. Comments included, “They’re very obliging” and “They understood our needs.” Staff were positively described as “patient and light-hearted.” Relatives confirmed that staff always turned up on time.

People’s relatives confirmed that members of the management team had called to seek their opinions on the quality of the service. Whilst nothing needed changing, they felt consulted. They told us that there was always someone available at the office if they called, and that people in the office listened to them.

People’s overall comments about the service were very positive. These included, “It’s very good. I’ve no complaints” and “They do very well. I like them very much.”